Wednesday, 22 May 2019

S Science

Neurodiversity And Comorbidities

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Repetitive movements, for example, are labelled as “personality traits” that can arguably be easily stopped at the whim of the individual. These behaviors are usually triggered by stress and may interfere with normal daily activities.  Repetitive or stereotyped behaviors include flapping of the arms, rocking of the trunk and wriggling of the toes.  Since these behaviors are part of their personality, ornaments as to what makes an individual unique, Neurodiversity advocates argue against medical interventions that would curtail their expression.  To readily agree with this proposal denotes lack of understanding and maybe empathy. As in many other instances, Neurodiversity proponents ignore the concept of severity and isolate themselves in a diagnostic cocoon that excludes those more severely affected.

Repetitive movements are chronic behaviors that can be momentarily suppressed. In some cases, self-stimulation (“stimming” behaviors) may serve to calm an individual who is confronting an overload of environmental stimulation.  These behaviors may also serve as a way of attracting the attention of caregivers when they are otherwise unable to properly express themselves through language.  In many cases, however, the reasons for stimming are complex and not fully understood.  However, at the other end of the spectrum, those repetitive behaviors that are maladaptive are hard to justify or reason. These behaviors, including head banging, head rubbing, eye gouging, self-biting, and picking at the skin, can be self-injurious and their severity is probably the greatest source of concern for the parents of those so affected. As with stimming, people may partake in these self-injurious behaviors as a way to relieve tensions and unwanted emotions. It has also been hypothesized that someone may exhibit these behaviors as a way of forcing themselves to feel stimuli when they themselves are otherwise hyposensitive.  Side effects of self-injurious behaviors include broken bones, retinal detachment, and death. There is nothing rosy about self-injurious behaviors. Calling them a personality trait does not preclude them from being a medical condition which, in many occasions, require treatment.  Self-injurious behaviors are not a gift but a disability to those who have them. At the very least, repetitive behaviors should not be considered as part of someone’s personality.

Another disabling feature of autism relates to sensory problems. The brain’s filtering mechanism in autism reacts differently to that of neurotypicals. All senses are affected and, at any given time, an individual may be over or under reactive to a given stimuli. This creates a truly frightening environment to the autistic child.  I usually talk about the “dangling or bat child” as being a sign of autism. An infant who avoids and over reacts to touch may throw him/her-self backwards when a parent attempts to carry the child.  Temple Grandin has called her sensory problems a major handicap and has received chronic treatment for the anxiety that they, and other attributes of autism, have seemingly procreated.  The severity of sensory symptoms in some autistic individuals is a disability, not a gift.


Neurodiversity proponents believe that seizures are a comorbidity of autism.  They use the term comorbity to indicate that seizures co-occur with autism but are otherwise independent of each other.  This is an important distinction as lack of overlap denotes that one is not a consequence of the other; not an expression of autism but rather a putative “complication”.  However, two thirds of autistic individuals exhibit electroencephalographic brainwave abnormalities and one third of cases manifest seizures. The latter are in many cases multifocal and recalcitrant to medical intervention.  In syndromic autistic individuals (e.g., Dravet syndrome) the presence of seizures is a diagnostic feature of the condition.  In many of these patients the genesis of seizures is borne from a defect in neuronal migrations. Primitive cells during brain development fail to reach their target site and remain behind as seizure prone islands of cells that otherwise serve no useful function.  The fact that autistic individuals have an excitatory/inhibitory imbalance of the brain has been used as an explanation for sensory and cognitive abnormalities.  Autistic individuals are tweaked towards this imbalance by risk genes that mediate the function of inhibitory neurotransmitters.  Having this excitatory/inhibitory imbalance is at the core of autism; it is part of whom they are. In a significant number of cases, this imbalance is expressed as seizures. This is not a comorbidity, this is not a different and unrelated condition, seizures and sensory problems are part and parcel of being autistic.


In my previous discussions with Neurodiversity advocates it has been their contention that having seizures is a blessing. They call epilepsy, as others throughout history, the Sacred Disease.  As with many of their other arguments this denotes ignorance and lack of empathy. Seizures can affect your state of alertness, mood and memory. Falls during seizures can cause broken bones. Kids with intractable seizures have to wear protective helmets all of the time. The mortality rate is increased in persons with autism who also have epilepsy. Seizures is part of autism. Seeing autism through pink colored glasses should not detract anybody from the fact that this is a medical disorder for which many individuals need treatment.


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