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  • October 27, 2016
  • 06:19 AM

Climate change, the long view

by gdw in FictionalFieldwork

Now and forever, or at least for a very long time By 2050, sea levels will have risen this much. If we don’t act, average global temperature will rise x degrees by 2100. These are the things we all hear in the discussion concerning climate change and its consequences. But beyond the turn of the […]... Read more »

Clark, P., Shakun, J., Marcott, S., Mix, A., Eby, M., Kulp, S., Levermann, A., Milne, G., Pfister, P., Santer, B.... (2016) Consequences of twenty-first-century policy for multi-millennial climate and sea-level change. Nature Climate Change, 6(4), 360-369. DOI: 10.1038/nclimate2923  

  • October 27, 2016
  • 05:00 AM

Autism and inborn errors of metabolism

by Paul Whiteley in Questioning Answers

I'd like to think that the review article by Annik Simons and colleagues [1] (open-access) highlights some pretty strong evidence to suggest there being at least some connection between some autism and some of the collected inborn errors of metabolism. Indeed, when people generally talk about 'not knowing what causes autism' if we perhaps consider a more plural view of 'the autisms', there is a case to be made to say we might know what causes 'some' autism and some of it might lie in this area...Inborn errors of metabolism (IEM) cover a whole host of different conditions "in which there is an accumulation of toxic and/or complex compounds or energy problems within the cells due to enzymatic defects or other protein dysfunction." The absolutely magnificent work of people like Robert Guthrie who's name is synonymous with the neonatal heel prick test offered to newborns to screen for various IEMs and a jobbing physician called Ivar Asbjørn Følling who lent his name to a condition that was eventually called phenylketonuria (PKU), have proved to be some of the real successes of modern medicine.For quite a few years, peer-reviewed science has suggested some potentially important 'associations' between various behavioural and psychiatric labels manifesting in both treated and untreated IEMs (see here and see here for examples). Simons and colleagues decided to look through the collected research on this topic to provide "child and adolescent psychiatrists with an overview of metabolic disorders associated with child psychiatric symptoms, their main characteristics and recommendations for further investigations."So after boiling down the available peer-reviewed literature to some 71 articles (and in so doing making an important distinction between an inborn error of metabolism and the 'metabolic syndrome'!) authors summarise some of the key IEM associated with labels such as autism, attention deficit hyperactivity disorder (ADHD), learning disability, psychosis and eating disorders. Given that (a) the paper is open-access and (b) this blog tends to favour autism research, I'm gonna focus in on some of the details pertinent to the autism spectrum. I do however recognise that when it comes to the term 'over-represented comorbidity' in autism some of the other diagnostic labels covered by Simons et al might also come into the frame.Long quote coming up: "Known metabolic disorders in autism are phenylketonuria, disorders in purine metabolism (such as adenosine deaminase deficiency, adenylosuccinate lyase deficiency, dihydropyrimidine dehydrogenase and dihydropyrimidinase deficiencies), organic acidurias (such as propionic academia, 3-methylcrotonyl-CoA carboxylase deficiency and pyridoxine dependency), disorders of branched-chain amino acids creatine deficiency, biotinidase deficiency, cerebral folate deficiency, succinic semialdehyde dehydrogenase deficiency, Smith–Lemli–Opitz syndrome (SLOS), late infantile ceroid lipofuscinosis, histidinemia, Sanfilippo disease, glucose 6-phosphate dehydrogenase deficiency, urea cycle disorders, X-linked ichthyosis, and mitochondrial disorders." I've popped in a few links to other occasions where a specific IEM has been associated with autism and covered on this blog.Simons and colleagues also cover some of the important research findings where specific amino acids have been analysed and found in unusual levels in cases of autism as potentially being important too. This is relevant because disordered amino acid levels as noted in the case of phenylketonuria (PKU) and the aromatic amino acids phenylalanine (and tyrosine) can be an important finding in relation to some IEM. That they specifically focus on some of the research looking at homocysteine levels and autism is rather interesting (see here) and something that I am going to be discussing in future posts.What's more to say? Well, I think it is also important to highlight how Simons and colleagues talk about 'other signs and symptoms of the metabolic disease' [IEM] alongside the presentation of autism. This is important in the context that science is starting to more fully understand how a diagnosis of autism rarely exists in some sort of diagnostic vacuum (see here) and quite a lot of different types of comorbidity seem to be 'over-represented'. I'd be inclined to suggest that this detail provides even stronger evidence for how IEM and at least some autism represent an important partnership.Finally, I refer back to one of the statements made by the authors on "recommendations for further investigations." They suggest that those presenting with: "A positive family history of metabolic disease... Symptoms or signs are triggered by food intake (esp high protein content foods), fever, fasting, surgery (catabolism)... Feeding difficulties, food refusal, failure to thrive, eating disorders combined with symptoms of myopathy or fatigue... Mental retardation and/or regression... Epilepsy, episodes of lethargy or confusion... Dysmorphic feature" should be considered for further investigations. Yes, some of the language is not what I would use and yes, that covers quite a bit of clinical ground but screening is the first part to ruling out such a potential organic correlate of some autism and may in some cases, yield potentially important insights (see here)...----------[1] Simons A. et al. Can psychiatric childhood disorders be due to inborn errors of metabolism? European Child & Adolescent Psychiatry. 2016. Sept 30.----------Simons A, Eyskens F, Glazemakers I, & van West D (2016). Can psychiatric childhood disorders be due to inborn errors of metabolism? European child & adolescent psychiatry PMID: 27695954... Read more »

  • October 27, 2016
  • 02:30 AM

What makes foreigners weird? A quick guide to orientalism

by Ingrid Piller in Language on the Move

One of the central arguments of my book Intercultural Communication is that, even today, much intercultural communication is approached from...... Read more »

Piller, I. (2011) Intercultural Communication: A Critical Introduction. Edinburgh: Edinburgh University Press. info:/

  • October 26, 2016
  • 10:30 AM

Study Shows Just How Stressed Dogs Are at the Vet's

by CAPB in Companion Animal Psychology Blog

Most dogs show signs of impaired welfare at the vet, according to their owners.A survey of 906 dog guardians in Italy found most people report their dog as being stressed at all stages of the visit to a vet clinic, from being in the waiting room to being examined by the vet. 6.4% of dogs had actually bitten their guardian at the vet and 11.2% had growled or snapped at the vet.The report by Chiara Mariti (University of Pisa) et al draws important conclusions about what owners and vets need to do to help dogs at the vet, including teaching them to be handled.The scientists write, “It is in fact alarming that only one third of dogs seemed to tolerate all kinds of clinical handling carried out by the vet.“The proportion of guardians who resorted to scolding their dogs if they refused to be treated is also alarming. Veterinary surgeons have a duty to ensure their patients’ welfare, and therefore, they should take advantage of every situation to advise guardians that the use of punishment is not recommended due to its negative implications on dog welfare and behavior.”Most of the dogs (89.9%) had had regular visits to the vet since they were a puppy, so you might think they were used to going to the vet.But many owners (39.7%) said their dog already knew they were going to the vet while they were in the car, and 7.4% before they had even left home. Add in the dogs who showed signs of stress as soon as they arrived (52.9%), and over three quarters of dogs are said to show signs of stress before they even make it in to the waiting room.Dogs who were stressed at the early stages of the visit were more likely to be stressed at the later stages too.Most people were able to give at least some treatments to their dog at home (50.6%) and 47% said they could give all treatments. However, about two thirds said they had sometimes had difficulty.Of those who struggled to give treatments, most scolded the dog and then did the treatment anyway (72.4%). This is unfortunate because scolding the dog does not teach them to accept the treatment and can make things worse in the future. Only 14% of owners did not scold the dog in these circumstances.In fact there was a correlation between scolding the dog when owners found it hard to give a treatment and aggressive behaviour towards the vet. This was the case whether the owner scolded the dog and did the treatment anyway, or scolded the dog and abandoned treating them.People’s assessments of their own dog at different stages of the vet clinic showed the majority had impaired welfare at each stage, except for the transition from waiting room to consultation room. Even then, 30% of dogs had to be encouraged and 16% had to be carried into the room.The paper makes many important recommendations for both dog owners and vets.Dr. Chiara Mariti, first author of the paper, told me in an email, “To the owners, I would suggest to get the dog becoming habituated to the veterinary clinic, to being handled, and to being exposed to common clinical practices. This means to gently, gradually and progressively familiarize puppies with manipulations (to being touched all over their bodies and used to the most unpopular treatments, such as temperature measurements and ear examinations), associating any kinds of handling with positive emotions and stimuli.“Also a positive association with anything related with the travel can help. Courtesy visits to the clinic, just to familiarize with the place and the vet without any interventions, and real visits since puppyhood are strongly recommended.“More importantly, in case dogs refuse to be treated by their owners, the latter should not scold the dog, but rather trying to understand the problem, being gentle, and maybe to ask for a behaviourist’s help.”Photos: Tinxi (top) and melis (both everyone said the vet tried to give their dog food, but 37% of dogs would not take it. Food is a very good way to help animals at the vet but an animal that is too stressed will not eat. This result suggests vets need to learn how to use food to help their patients, and how to keep their patients from getting so stressed they will not eat.Only a third of owners said their dog would let the vet handle them anywhere.Vets did make some attempt to talk to the dog (53%), use the dog’s name (40%) and pet them (53%) but this was not enough to make dogs comfortable. It was still helpful, because dogs whose vet did not do this were more likely to be stressed in the waiting room, on the exam table, and when the vet approached.There are clear consequences for a vet’s business, because about a third of participants said they had previously changed vet. The most common reasons were because they did not think the vet was competent (24.5%) or because of the vet’s attitude to their dog (18%).Dr. Mariti says, “My advice for the vets: make sure you are protecting your patients' welfare, that is a duty of your profession.“Vets can work at different levels, from the education of owners (handling and habituation of puppies, appropriate treatments at home, avoiding any kinds of punishment, including scolding…) to the preparation of the clinic to make it as much dog-friendly as possible: the place, the kind of handling, noises, and the presence of conspecifics and strangers can be stressful for some dogs, and this may be a relevant welfare issue especially in cases where the dog has to visit the veterinary clinic regularly or if recovery is long.“Vets behaviour is also relevant, as dogs feel calmer when the vet spends some time interacting with them before the visit.”The finding that many dogs seem to know where they are going in advance of arriving at the vet has important implications too. The scientists say for some dogs there is a risk of developing a more generalized anxiety disorder. They also say it suggests dogs have learned when they are going in the car to the vet rather than somewhere else. For dog owners, this shows the importance of also taking the dog for pleasant outings, so they don’t learn to be afraid of the car.This research confirms that vet visits are stressful for many dogs. An earlier study observed 45 dogs in the waiting room at the vet (Mariti et al 2015) and found that 29% were highly stressed according to signs noted by a veterinary behaviourist including trembling, low tail, lowered ears, and trying to leave. Taken together, these studies show that both dog owners and vets need to take steps to improve canine welfare at the vet.Many cats also find vet visits stressful.There is a lot we can do to make vet visits better for our canine and feline companions. These days, there are some excellent resources on how to help dogs and cats be less stressed at the vet. What do you do to try and reduce stress for your dog at the vet?For more stories like this, subscribe to Companion Animal Psychology.ReferenceMariti C, Pierant... Read more »

  • October 26, 2016
  • 07:42 AM

'Super-parenting' improves children's autism: headline fail as PACT re-emerges...

by Paul Whiteley in Questioning Answers

The title of this post is partially taken from the BBC take on the findings reported by Andrew Pickles and colleagues [1] detailing a long-term follow up (and slight adjustment to the calculation of behavioural scores) of the Preschool Autism Communication Trial (PACT). PACT by the way, is a strategy based on the important tenet of shared attention where: "The approach aims to help parents adapt their communication style to their child’s impairments and respond to their child with enhanced sensitivity and responsiveness."OK, just before I get started, use of the term 'super-parenting' in that headline is a bit of a fail by my reckoning and I don't doubt that this will probably change/have changed quite soon. Appreciating that there is as much variability in parenting a child with autism as there is parenting a child who does not have the label, the implication that parents of autistic children are somehow 'not doing it right' made by such a headline is frankly, a little rude. Many parents with children with autism are already 'super-parenting' well beyond what you might imagine to be humanly possible.The study... well, greeted with quite a fanfare as words like 'breakthrough' are used (see here for example) the findings are basically a longer-term follow-up of the original PACT trial [2] which unfortunately reported at the time: "On the basis of our findings, we cannot recommend the addition of the PACT intervention to treatment as usual for the reduction of autism symptoms." Indeed, allied to some of other quite high-profile unspectacular scientific results based on the analysis of short-term parent-mediated intervention discussed on this blog (see here), there is quite a U-turn seemingly being adopted in this area (see here too). I might also add that even an analysis of the cost of PACT vs treatment as usual (TAU) did "not support the cost-effectiveness of PACT + TAU compared to TAU alone" [3]!That all being said, the recent results from Pickles and colleagues are not bad at all. Tracking down some 120 participants of the original 150-ish cohort, researchers assessed them [blinded in some cases] "with the ADOS Comparative Severity Score (CSS)" among other things to see whether there were any behavioural presentation differences between those who were in receipt of PACT vs. those assigned to TAU. Differences were noted: "the severity of autism symptoms was significantly lower for children in the intervention group than for children in the treatment-as-usual group." And with that the authors pronounce: "We now show that a 12 month parent-mediated preschool intervention can produce sustained improvement in child autism symptoms and social communication with parents, which remained at nearly 6 years after the end of treatment. These findings support the potential long-term effects and value of early parent-mediated interventions for autism." I might also add: "these results are encouraging and provide evidence that sustained changes in autism symptoms can be possible after early intervention, something that has previously been regarded as difficult to achieve."Caveats? Well, there are a few, not least the observation: "we cannot be sure how our results would generalise to young children with less severe symptoms." The authors also stress that the word 'cure' is not part and parcel of their results, and when it came to important comorbidities such as anxiety: "our related hypothesis that levels of child anxiety, which are often linked to levels of restricted and repetitive behaviours in autism,would also show a treatment effect at follow-up was refuted." Autism rarely exists in a diagnostic vacuum. Given also the quite long time between original and follow-up, it's not outside of the realms of possibility that other 'interventions' may also have 'chipped in' when it came to contributing to the behavioural outcomes noted or there being some element of natural waxing and waning of symptoms at work for some.For the scientific sticklers out there (good on yer!), there are also a few details included in the study appendix pertinent to protocol and analysis amendments that were included in the study as it is presented, including dropping the Autism Diagnostic Interview-Revised (ADI-R) from the assessment battery and reported results. Does this mark the beginning of the end for the ADI-R I wonder?So there you have it. After a slightly shaky start potentially illustrative of only modest short-term effects, early intervention of this type might actually have some more positive longer term effects. Of course, I'd like to see some further independent replication of this study and such behavioural intervention does not disqualify other approaches as also potentially being useful for some on the autism spectrum (see here for example). It's all about getting the right support and strategies in place for each individual person and perhaps getting the timing right too (see here).----------[1] Pickles A. et al. Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial. Lancet. 2016. Oct 26.[2] Green J. et al. Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial. Lancet. 2010 Jun 19;375(9732):2152-60.[3] Byford S. et al. Cost-effectiveness analysis of a communication-focused therapy for pre-school children with autism: results from a randomised controlled trial. BMC Psychiatry. 2015 Dec 21;15:316.----------Pickles, A., Le Couteur, A., Leadbitter, K., Salomone, E., Cole-Fletcher, R., Tobin, H., Gammer, I., Lowry, J., Vamvakas, G., Byford, S., Aldred, C., Slonims, V., McConachie, H., Howlin, P., Parr, J., Charman, T., & Green, J. (2016). Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial The Lancet DOI: ... Read more »

  • October 26, 2016
  • 07:02 AM

Are spouse killers “wicked” or  “stressed”?

by Rita Handrich in The Jury Room

While it may be 2016, there are still some judges who view women and men differently even when they commit the same offense. When it comes to killing your spouse—apparently, the difference lies in the gender of the defendant. Australian researchers looked at the sentencing remarks from nine different judges from trials involving men killing […]

Related posts:
Does race make a difference in how jurors perceive  battered spouse syndrome cases?
Female serial killers: Who they are and how they kill
Black victims of violent crimes aren’t treated any better by the system than Black defendants …

... Read more »

  • October 26, 2016
  • 05:25 AM

"Increased risk for substance use-related problems in autism"

by Paul Whiteley in Questioning Answers

"We aimed to investigate the risk of substance use-related problems in ASD [autism spectrum disorder]."Findings: "The risk of substance use-related problems was the highest among individuals with ASD and ADHD [attention-deficit hyperactivity disorder]."So said the findings reported by Agnieszka Butwicka and colleagues [1] (open-access) looking again at an important but slightly uncomfortable topic: substance use-related problems or substance use disorder (SUD) with autism in mind. Covering various issues including those related to alcohol, drugs, tobacco, crime, somatic disease and death, authors "identified 26,986 probands with an autism spectrum disorders (ASD) among all individuals born in Sweden between January 1, 1973 and December 31, 2009" (yes, yet again it was one of those Scandinavian population registries that provided the data). Data from those diagnosed with autism or ASD were cross-referenced with information on substance-use related problems and compared with "unaffected (without an ASD diagnosis) full siblings (N = 30,456), half-siblings (N = 15,946), and parents (N = 50,155) of probands with ASD." Researchers also took into account issues such as comorbidity - "stratified on probands’ psychiatric comorbidity with ADHD" - and disposable family income and parental education. The examination of ADHD + autism continues an important research direction in recent times (see here).Results: "Probands had a substantially increased risk of any substance-related problem..., such as substance use disorder..., somatic disease linked to alcohol misuse..., substance-related crime... and death." The sorts of statistics being produced with regards to 'risk' were not unimportant and indeed, were quite contrary to the 'stereotyped' view that "ASD patients are somehow protected from substance use-related problems" (authors words not mine). Further: "Within the substance use disorder category, the highest risk was found for drug use disorder..., followed by tobacco... and alcohol use disorder." The risk figures remained similar even when parental age, region of birth, education and family income were taken into account.Insofar as one of the opening sentences of this post suggesting that autism + ADHD might be a particularly 'sensitive' combination when it comes to substance-use related problems, the data is pretty stark: "comorbid ADHD or ADHD with ID [intellectual disability] entailed a substantially higher risk, especially for substance use disorder." Autism + ID (without ADHD) however "was not associated with an increased risk of any substance use-related problems..., when all outcomes where regarded as one group."I don't really want to go too far into the 'hows and whys' of the Butwicka data because this important area of investigation is still in it's infancy. I do appreciate the authors' discussions on how "substance use-related problems in individuals with ASD were indeed less common in the past, but that some factor(s) caused an increase over time" as being potentially important. They for example, talk about how "prior more narrow diagnostic practice may have [previously] excluded ASD patients with substance use-related issues or assigned other diagnoses to them." In other words, taking also into account how autism +ID did not seem to substantially increase the risk of substance use-related issues, the widening of the autism spectrum to potentially include more people might have had some effect on the relationship examined [2]. Obviously, if true, this might have some important implications particularly when it comes to screening and also questioning what role substance use serves for this group in terms of reason(s) for starting and maintaining such behaviour(s).The important autism + ADHD relationship also picked out by the authors is noteworthy. On several occasions on this blog I've discussed the cold, hard science that suggests that long-term outcome following a diagnosis of ADHD is not exactly brilliant when it comes to various individual and social variables (see here and see here for example). Without trying to generalise/stigmatise nor shift 'blame' from label to label, it's not outside the realms of possibility that comorbid ADHD diagnosis or even features of ADHD, might exert a significant influence on substance use behaviours [3] and the related problems stemming from their use. The implication is therefore, that efforts to minimise such adverse effects linked to a label of ADHD perhaps need to be stepped up.It's always going to be difficult to talk about substance use disorder and the problems stemming from such behaviours with any specific diagnostic label in mind. There is a particular stigma attached to substance-use behaviours and certainly with autism in mind, more adverse sweeping generalisations are not required (see here for example). But this should not mean that discussions are buried and reality somehow airbrushed for the sake of political correctness or positive public relations. The reality as demonstrated by the Butwicka and other peer-reviewed data [4] is that substance use is / can be a destructive behaviour not least for the person and the people around them. Certainly in the context of autism and the quite large health and social disparities that seem to continually surround the diagnosis (see here for example), a failure to screen for and tackle substance use behaviours further adds to the adverse risks/inequalities that can potentially accompany a diagnosis.----------[1] Butwicka A. et al. Increased Risk for Substance Use-Related Problems in Autism Spectrum Disorders: A Population-Based Cohort Study. J Autism Dev Disorder. 2016. Oct 12.[2] Clarke T. et al. Substance use disorder in Asperger syndrome: An investigation into the development and maintenance of substance use disorder by individuals with a diagnosis of Asperger syndrome. Int J Drug Policy. 2016 Jan;27:154-63.[3] Connolly RD. et al. Probabilities of ADD/ADHD and Related Substance Use Among Canadian Adults. J Atten Disord. 2016 May 14. pii: 1087054716647474.[4] Arnevik EA. & Helverschou SB. Autism Spectrum Disorder and Co-occurring Substance Use Disorder - A Systematic Review. Subst Abuse. 2016 Aug 17;10:69-75.----------Butwicka, A., Långström, N., Larsson, H., Lundström, S., Serlachius, E., Almqvist, C., Frisén, L., & Lichtenstein, P. (2016). Increased Risk for Substance Use-Related Problems in Autism Spectrum Disorders: A Population-Based Cohort Study Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-016-2914-2... Read more »

Butwicka, A., Långström, N., Larsson, H., Lundström, S., Serlachius, E., Almqvist, C., Frisén, L., & Lichtenstein, P. (2016) Increased Risk for Substance Use-Related Problems in Autism Spectrum Disorders: A Population-Based Cohort Study. Journal of Autism and Developmental Disorders. DOI: 10.1007/s10803-016-2914-2  

  • October 25, 2016
  • 07:35 PM

Why do polar bears mock battle? and other facts about polar bear reproduction

by Emily Makowski in Sextraordinary!

Inspired by an Instagram photo of polar bears playfighting, I decided to find out more about this strange behavior and learned many interesting things about polar bear reproduction.... Read more »

Fitzgerald KT. (2013) Polar bears: the fate of an icon. Topics in Companion Animal Medicine, 28(4), 135-42. PMID: 24331553  

  • October 25, 2016
  • 05:27 AM

Vitamin D toxicity and autism: a case report

by Paul Whiteley in Questioning Answers

"Alternative medicine treatment put four-year-old boy in A&E [accident & emergency / emergency room]" went the recent BBC headline talking about the case report published by Drs Catriona Boyd and Abdul Moodambail [2].Describing the experiences of a 4-year old boy who attended A&E (the emergency room) following an extended period of "vomiting, loss of appetite, constipation, polyuria, polydipsia and loss of 3kg in weight" in previous weeks, the authors report how after an unremarkable series of test results, parents disclosed that "for a number of months he had been taking 12 different holistic supplements recommended to the family by a naturopath to help with his autism."Coinciding with the detected presence of hypercalcaemia - high calcium levels in the blood - and a circulating vitamin D level that was pretty much off the scale ("Vitamin D level was checked and was 2130 nmol/L (normal range: 50-150 nmol/L)") authors set about correcting such issues and eventually reported that he "has had no further problems since stopping the supplements." His symptoms by the way, matched other reports of vitamin D toxicity present in the peer-reviewed literature [2]. Insofar as any long-term side-effects associated with this case, well, we just don't know yet.Whilst this is an unfortunate incident, there are a number of important wider points potentially raised from such a case report worth mentioning. So, treading very carefully:1. Quite a lot of the media chatter about the Boyd/Moodambail report has focused on the more general role of complementary and alternative medicine (CAM) particularly when applied to autism (see here). The authors, in that BBC news report, stress as much with comments like: "When some complementary and alternative therapies are suggesting they can cure these situations, these parents get a hope - which is probably a false hope." Bearing in mind what was actually being reported on in their paper - hypercalcaemia and vitamin D toxicity - primarily due to either/combined excessive calcium intake and vitamin D supplementation and as far as I can see, no mention of the word 'cure' in the case report when it comes to the reasoning behind their use, one has to be a little cautious about turning such reports into something more than they are. Vitamin D - the sunshine vitamin/hormone - is an important nutrient as science and (UK) Government health policy is starting to realise (see here) and this includes that research potentially relevant to [some] autism (see here). Indeed, a response to the Boyd/Moodambail paper highlights this fact. This case report highlights how we should be treating our nutritional supplements as what they are - medicines - and how professional medical advice should always be sought when it comes to their use including that related to dosage and importantly, any contraindications. I might also suggest that this case highlights the value of screening before and during supplementation [3] - "obtaining serum 25-hydroxyvitamin D levels in infants and children who receive long-term vitamin D supplementation at or above the upper level intake that is currently recommended". The further question of 'whether vitamin D actually comes under the auspice of CAM' also surfaces. I'm sure many people will have different opinions about this but like other important vitamins (e.g. folic acid) where specific government advice is available, I'd be inclined to say not anymore.2. There were some rather extreme reactions to this paper/story when it broke. Despite the fact that "The safeguarding team became involved as well as the police to investigate the naturopath who had advised the therapies" some people were calling the parent's actions as being tantamount to 'child abuse'. I however go with the authors on this one where the parents were naive at worst and perhaps far too trusting. Such a response does however intersect with various other thoughts and opinions in relation to autism and its' 'treatment' and calls by some for more regulation when it comes to the vast number of interventions being put forward 'for autism'. There are no easy answers to this because as well as balancing parental responsibility with the health and wellbeing of the child, blanket calls to 'ban all nutritional supplements for children/adults with autism' for example, are neither practical nor enforceable. Indeed, it could be viewed as discriminatory given our population habits when it comes to such pharmaceutics. I might also add that if one assumes that 'autism' should be replaced by the more plural 'autisms', peer-reviewed science has actually suggested that the presentation of some of the 'autisms' may be potentially amenable to certain dietary or nutritional intervention as function of their underlying genetics/biology (see here for example). The bottom line is that as long as autism remains a 'singular mysterious condition' where very little information about aetiology and life course exists, so these sorts of scenarios will unfortunately continue to occur.3. Finally, very little discussion has centred on the individual supplements 'recommended' in this case outside of those containing calcium and vitamin D. Cod liver oil is mentioned "(containing 1000IU vitamin D") alongside camel milk, zinc, Epsom salts baths and something called AFP peptizyde. I'm sure some people might see these kinds of interventions as pure 'woo' when it comes to autism but it's perhaps important to realise that there is some preliminary peer-reviewed science behind some elements of them (see here and see here for example). Focusing specifically on cod liver oil and the idea that as well as containing vitamin A (be careful with that one) and vitamin D it contains some of those essential fatty acids that everyone keeps going on about these days, the suggestion that certain facets of cognition could be 'affected' by their inclusion as a supplement for some continues to gain scientific ground (see here). Obviously quite a lot more investigation needs to be put into the 'hows and whys' of their possible actions and mechanisms of effect with a specific focus on autism, onwards to the identification of criteria for potential best or non-responder to such approaches.The Boyd/Moodambail report represents an important example of how supplements that can be easily purchased in-store or on-line are not just benign tablets or pills but can have very real physical effects if used inappropriately or without the right medical consultation. I certainly don't want to downplay the 'suffering' that the child in their report went through which ultimately led him to be hospitalised with some pretty serious health issues. I do however object to the '... Read more »

  • October 24, 2016
  • 01:42 PM

Study uncovers brain changes in offending pedophiles

by Dr. Jekyll in Lunatic Laboratories

New research reveals that certain alterations in the brain may be present in pedophiles, with differences between hands-on offenders and those who have not sexually offended against children.

... Read more »

  • October 24, 2016
  • 11:19 AM

Exercise After Study Boosts Memory

by William Yates, M.D. in Brain Posts

There is significant interest in activities that may boost academic achievement in the classroom.I previously posted on evidence that exercise prior to a learning task improved reading comprehension scores.You can access that post by clicking HERE.Now a study has compared two types of activities after a memorization task in male students.In this study, 60 male students completed a learning task and then were randomized into one of three activities for one hour. The three activities were playing a violent video game, a period of running or a control period of conversation. After the activity period, subjects completed a memory test.Subjects had salivary cortisol levels examined before and after the learning task at at the time of memory testing. All subjects had a increase in salivary cortisol levels after the learning phase, but only the running group demonstrated a continued rise in cortisol after the activity phase.The subjects participating in a running activity performed better on the memory retention test than those in the violent video game and the conversation control groups.  There was no correlation between salivary cortisol levels and memory retention. The authors conclude that their finding has implications for scheduling exercise during the school day for children. They recommend physical exercise following intense learning cycles to promote improved learning efficiency.Interestingly, in the United States many schools are cutting back on physical education activities due to budget constraints. Such cutbacks may contribute to declining performance on testing metrics.Readers with more interest in this topic can access the free full text manuscript by clicking on the DOI link in the citation below.Photo of monarch butterfly is from the author's files.Follow me on Twitter at WRY999Kindermann, H., Javor, A., & Reuter, M. (2016). Playing counter-strike versus running: The impact of leisure time activities and cortisol on intermediate-term memory in male students Cognitive Systems Research, 40, 1-7 DOI: 10.1016/j.cogsys.2016.01.002... Read more »

  • October 24, 2016
  • 07:02 AM

Empathy, need for cognition, getting it right and hair  transplants

by Doug Keene in The Jury Room

It is yet another installment of things you want to know for voir dire, your personal appearance and choices, and how our country rates on caring for others. Sit back, educate yourself, and return to the fray with tidbits that will heighten your reputation among your co-workers for useful and inspirational pieces of information. “Need […]

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Empathy: Paving the road to preferential treatment with good intentions
Men: Exude confidence, masculinity, authority, and power!
“His brain made him do it” and so I feel much less empathy for him 

... Read more »

  • October 24, 2016
  • 04:22 AM

Bipolar disorder and the autism spectrum continued

by Paul Whiteley in Questioning Answers

In a previous post on this blog I talked about an important paper by Vannucchi and colleagues [1] summarising the state of the peer-reviewed research (up to 2014) on bipolar disorder and Asperger syndrome (AS). Today, I'm adding to the conversation on this important topic by introducing two papers to the discussions: the first by Xenia Borue and colleagues [2] and the second by Ahmad Abu-Akel and colleagues [3] covering the longitudinal course of bipolar disorder (BD) in relation to autism and the appearance of autistic and other traits in relation to cases of BD respectively.Bipolar disorder (BD) previously known as manic depression is a condition affecting mood and specifically how it can 'swing' between extremes of depression and mania. There are a couple of different 'types' of BD reflective of how such mood swings can sometimes centre more on one aspect of BD over the other. As per the Vannucchi findings, the experience of BD may not be uncommon to the autism spectrum - "BD prevalence in adults with AS ranges from 6% to 21.4% of the cases" - but importantly: "is often characterized by atypical presentation, making its correct identification particularly difficult." Keep that in mind for now.The papers by Borue and Abu-Akel put a little more scientific flesh on to the discussions about autism and BD. Specifically, how in these days of increasing recognition that autism rarely appears in some sort of diagnostic vacuum (see here), comorbidity might have some pretty important effects on clinical presentation.To discuss the Borue findings first... well, based on a cohort of some 360 youths diagnosed with various types of BD who were followed for around 9 years, authors "compared youth with and without ASD [autism spectrum disorder] on clinical presentation, percentage of time with mood symptomatology, and psychosocial functioning." Approximately 8% of their cohort "met DSM-IV criteria for Asperger disorder or pervasive developmental disorder-NOS (referred to here as ASD)" which is an important detail. Further: "Compared to youth with BD, the clinical presentation of youth with BD+ASD more frequently involved distractibility, racing thoughts, depressed mood, social withdrawal, and low reactivity of negative mood states." The 'distractibility' side of things tallies with the observation that comorbid "attention-deficit/hyperactivity" (akin to ADHD) was more frequent in this group too and might be important [4]. Insofar as longitudinal course (at least over about 9 years), authors note: "Significant amelioration of clinical symptoms occurred over time, suggesting that early recognition and treatment of mood disorders in youth with ASD may improve clinical outcomes."The Abu-Akel group set out to "determine the expression of autistic and positive schizotypal traits in a large sample of adults with bipolar I disorder (BD-I), and the effect of co-occurring autistic and positive schizotypal traits on global functioning in BD-I." BD-I focuses more on the manic side of clinical presentation. Bearing in mind autistic and schizotypal traits were self-assessed, authors reported that nearly 50% of their BD cohort (~800 people recruited via the Bipolar Disorder Research Network) "showed clinically significant levels of autistic traits." Around a quarter of their group also showed potentially important schizotypal traits too. Interestingly: "In the worst episode of mania, the high autistic, high positive schizotypal group had better global functioning compared to the other groups" with the requirement for quite a bit more study in this area.What could these collective results mean?Well, first and foremost all the chatter about traits and behaviours 'overlapping' shines through in these results. ESSENCE may indeed extend quite a bit further than just in childhood (see here) and this has some important implications for preferential screening services when an autism diagnosis is suspected or given. Second, I'm struck by how important traits outside of the autism spectrum might be to the presentation of something like BD in those reaching clinical thresholds for autism. I'm yet more convinced that the increasingly important association being made between autism and ADHD for example (see here) is really, really important. Third, the idea that autistic and certain schizotypal traits might actually be useful when it comes to 'global functioning' in cases of BD-I is an eye-opener. This needs further investigation. Finally, treatment for BD exists and with no medical or clinical advice given or intended, should not be withheld on the basis of a comorbid autism diagnosis.Timely and accurate diagnosis of BD when co-occurring alongside autism (or the presence of autistic traits) continues to be a priority. Not least because of the potentially far-reaching and sometimes extreme effects that BD can have (see here for example) potentially overlapping with some distressing figures noted alongside autism (see here). Yes, the presentation of BD might be slightly different when autism/autistic traits are included in the diagnostic mix, but clinicians and other health professionals need to be sensitive to such subtleties. Once again, screening is the first step of the process...----------[1] Vannucchi G. et al. Bipolar disorder in adults with Asperger׳s Syndrome: a systematic review. J Affect Disord. 2014 Oct;168:151-60.[2] Borue X. et al. Longitudinal Course of Bipolar Disorder in Youth With High-Functioning Autism Spectrum Disorder. Journal of the American Academy of Child & Adolescent Psychiatry. 2016. Oct 4.[3] Abu-Akel A. et al. Autistic and Schizotypal Traits and Global Functioning in Bipolar I Disorder. Journal of Affective Disorders. 2016. Oct 3.[4] Wang HR. et al. Prevalence and correlates of bipolar spectrum disorder comorbid with ADHD features in nonclinical young adults. J Affect Disord. 2016 Sep 28;207:175-180.----------Borue, X., Mazefsky, C., Rooks, B., Strober, M., Keller, M., Hower, H., Yen, S., Gill, M., Diler, R., Axelson, D., Goldstein, B., Gol... Read more »

Borue, X., Mazefsky, C., Rooks, B., Strober, M., Keller, M., Hower, H., Yen, S., Gill, M., Diler, R., Axelson, D.... (2016) Longitudinal Course of Bipolar Disorder in Youth With High-Functioning Autism Spectrum Disorder. Journal of the American Academy of Child . DOI: 10.1016/j.jaac.2016.08.011  

Abu-Akel, A., Clark, J., Perry, A., Wood, S., Forty, L., Craddock, N., Jones, I., Gordon-Smith, K., & Jones, L. (2016) Autistic and Schizotypal Traits and Global Functioning in Bipolar I Disorder. Journal of Affective Disorders. DOI: 10.1016/j.jad.2016.09.059  

  • October 24, 2016
  • 03:05 AM

The Role of “Roll-Off” During Gait in Patients Recovering from a Lateral Ankle Sprain

by Revay O. Corbett, MS, ATC, PES in Sports Medicine Research (SMR): In the Lab & In the Field

People with persistent complaints 6 to 12 months after an ankle sprain walk differently than those without persistent complaints.... Read more »

  • October 23, 2016
  • 02:57 PM

Your BMI might affect your brain function

by Dr. Jekyll in Lunatic Laboratories

There are plenty of reasons it's important to maintain a healthy weight, and now you can add one more to the list: It may be good for your brain. Researchers have found that having a higher body mass index, or BMI, can negatively impact cognitive functioning in older adults.

... Read more »

  • October 22, 2016
  • 03:10 PM

Red meat and organs may pose a significant health hazard

by Dr. Jekyll in Lunatic Laboratories

Neu5Gc, a non-human sialic acid sugar molecule common in red meat that increases the risk of tumor formation in humans, is also prevalent in pig organs, with concentrations increasing as the organs are cooked, a study has found. The research suggests that Neu5Gc may pose a significant health hazard among those who regularly consume organ meats from pigs.

... Read more »

  • October 22, 2016
  • 06:00 AM

Does Effect Size Matter for fMRI?

by Neuroskeptic in Neuroskeptic_Discover

fMRI researchers should care about (and report) the size of the effects that they study, according to a new Neuroimage paper from NIMH researchers Gang Chen and colleagues. It's called Is the statistic value all we should care about in neuroimaging?. The authors include Robert W. Cox, creator of the popular fMRI analysis software AFNI.

Chen et al. explain the purpose of their paper:
Here we address an important issue that has been embedded within the neuroimaging community for a long tim... Read more »

  • October 22, 2016
  • 04:21 AM

Language and motor skills: preschool predictors of academic achievement in autism

by Paul Whiteley in Questioning Answers

A fairly quick post for your reading delight today as I bring the paper by Miller and colleagues [1] to your attention suggesting that: "Early intervention targeting language and motor skills may improve later achievement in this population."'This population' referred to a small cohort (N=26) of children diagnosed with an autism spectrum disorder (ASD) who were examined "at the approximate ages of two, four, and ten" years with regards to their academic achievement and the variables that might be important to 'successful' achievements.Including some familiar names when it comes to the concept of 'outcome' in relation to autism ('optimal outcome' that is), researchers determined a few potentially important relationships from their collected data: "Preschool verbal abilities significantly predicted school-age reading comprehension" and "early motor functioning predicted later math skills."I'm not entirely surprised that infancy verbal (talking) abilities might play a role in later reading comprehension but I was rather more intrigued by the observation potentially linking motor skills to later maths abilities. Yes, I get that children learn to count on their fingers (and toes) and no doubt this and other scenarios might influence the connection between the two, but it strikes me that this connection requires quite a bit more study [2]. Indeed, welcoming the idea that motor skills are an important issue with regards to autism (see here) and that maths ability is 'as varied as the label of autism is itself' (see here) the idea that the archetypal all-rounder that is the occupational therapist (OT) might have a key role here is rather interesting (see here).I'm also minded to suggest that a certain sport/discipline that I'm particularly fond of on this blog (the martial arts) might have some rather far-reaching 'mathematical' effects if one considers it's application to autism and motor functioning...To close, Marvel are going full-strength with their next Wolverine film instalment titled 'Logan'...----------[1] Miller LE. et al. Preschool predictors of school-age academic achievement in autism spectrum disorder. Clin Neuropsychol. 2016 Oct 5:1-22.[2] Pitchford NJ. et al. Fine Motor Skills Predict Maths Ability Better than They Predict Reading Ability in the Early Primary School Years. Front Psychol. 2016 May 30;7:783.----------Miller LE, Burke JD, Troyb E, Knoch K, Herlihy LE, & Fein DA (2016). Preschool predictors of school-age academic achievement in autism spectrum disorder. The Clinical neuropsychologist, 1-22 PMID: 27705180... Read more »

Miller LE, Burke JD, Troyb E, Knoch K, Herlihy LE, & Fein DA. (2016) Preschool predictors of school-age academic achievement in autism spectrum disorder. The Clinical neuropsychologist, 1-22. PMID: 27705180  

  • October 21, 2016
  • 03:15 PM

A new view of the immune system

by Dr. Jekyll in Lunatic Laboratories

Pathogen epitopes are fragments of bacterial or viral proteins. Attached to the surface structure of cells, they prompt the body's immune system to mount a response against foreign substances. Researchers have determined that nearly a third of all existing human epitopes consist of two different fragments. Known as 'spliced epitopes', these types of epitopes have long been regarded as rare. The fact that they are so highly prevalent might, among other things, explain why the immune system is so highly flexible.

... Read more »

Liepe, J., Marino, F., Sidney, J., Jeko, A., Bunting, D., Sette, A., Kloetzel, P., Stumpf, M., Heck, A., & Mishto, M. (2016) A large fraction of HLA class I ligands are proteasome-generated spliced peptides. Science, 354(6310), 354-358. DOI: 10.1126/science.aaf4384  

  • October 21, 2016
  • 05:39 AM

Chest CT in patients with spontaneous pneumothorax is cost-effective

by Joana Guedes in BHD Research Blog

Patients that present with a spontaneous pneumothorax (SP) without a known medical history of lung disease are usually diagnosed as primary spontaneous pneumothorax - a pneumothorax that occurs without underlying diseases. However, underlying diffuse cystic lung diseases such as Birt-Hogg-Dube syndrome (BHD), lymphangioleiomyomatosis (LAM) and pulmonary Langerhans cell histiocytosis (PLCH) may have a spontaneous pneumothorax as their first symptom. In their new study, Gupta et al. (2016) evaluate the cost-effectiveness of high resolution computed tomographic (HRCT) chest imaging for early diagnosis of LAM, BHD, and PLCH in patients presenting with an apparent primary SP. In their analysis the authors show that HRCT image screening for BHD, LAM and PLCH in patients with apparent primary SP is cost-effective and suggest that clinicians should consider performing a screening HRCT in these patients.... Read more »

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