Infants’ Surprising Abilities

Interesting that I should encounter this just now, while studying my dev psych textbook. Jonah Lehrer over at The Frontal Cortex had a great post a few days ago, which emphasized research into young children’s cognitive abilities. My textbook dates from 2002, and even though each chapter starts with Piaget, the authors acknowledge that his theory underestimates young children’s abilities due to fallacies in test set-up. However, merely criticizing the assumption of almost totally incompetent infants, goes not nearly as far as saying that children acquire all the important understanding of how the world works before the age of three.

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Autistic Woman Faces Forced Move to Locked Ward

Read in a Dutch newspaper that an autistic, 25-year-old woman will probably be sent into a locked institution placement, because she is no longer treatable and is “blocking an expensive treatment place”, as a psychiatrist at her current placement is quoted as saying. The woman, Heleen, has been on a waiting list for something called a workhome since 2006, but there still isn’t a place for her. Workhomes are combined living and employment facilities with intensive support, specifically for autistic adults. The main qualities of a workhome, that apparently make this the most suitable placement for Heleen, are the integratedness of all aspects of daily living, including employment, so that she won’t have to cope with the stress of multiple enviroments, and the specific, autism-related support she will be getting there.

Of course, autistic self-advocates may jump up and tell me that Heleen shouldn’t be in an institution at all – and both her current place and the workhome she is hoping to go to are technically institution-based, too -, but I will assume that Heleen and her mother think these are appropriate. The problem that arises now is that they are facing an involuntary commitment procedure that would land Heleen on a locked, general psychiatric ward for people with all sorts of mental illnesses. This place will be far too stressful, due to the unpredictability of the other patients. Staff will not be trained in autism, so will not know how to handle Heleen’s behavior – and if there happen to be staff who have some common sense, they will likely be too busy to give her appropriate support, because these wards are understaffed. As a result, it is quite possible that she will end up in an isolation room or involuntarily medicated with powerful drugs. Most of all, there will be no way she’ll be secure in this placement. And remember, it is not known when Heleen can transfer to the workhome. And the only reason Heleen may be moved to this entirely unsuitable place, is that her psychiatrist wants her to stop “wasting an expensive treatment place”. While I can understand the logic that you would want patients to move on in order to prevent further clogging up of waiting lists, it seems Heleen’s current doctors are utterly unwilling to cooperate with her mother on finding a more suitable facility.

Heleen’s mother, Emmy de Groot, is already undertaking legal action with help from the NVA (Dutch Association for Autism) to prevent her daughter from being moved to a locked ward and get her doctors to cooperate. Unfortunately, there is probably little to be done at this point, since the current place intends on starting the involuntary commietment procedure if the mother hasn’t given consent for the move by tomorrow, August 22, and these procedures usually only last a few weeks. Further, since my readership consists almost entirely of people unfamiliar with the Dutch mental health system, I’m not sure what I want from you all. However, maybe someone more familiar with autistic self-advocacy than I am has any ideas on how to help Heleen, if not in preventing the move, then in advocating for appropriate supports to be sought as soon as possible and doctors to cooperate with her mother.

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Studying Developmental Psychology

Probably most of you didn’t even know I have tried my hand at pretending that I’m again doing something that makes it seem like I’m in college again. Oh well, my boyfriend keeps telling me that I am in fact a student, but I don’t consider myself one if I take a year to complete a 4.3 European credit (with a full year having 60 ECs) course. Oh well, I could’ve finished the course earlier if I’d known that one’s request for accommodations should be with the examination commission eight weeks in advance – and they took exactly eight weeks to decide mine accommodations were granted. But right now I do feel like a student, since I’m finally working towards my first exam. I am enrolled in some distance-learning psychology courses at Open University, and next week’s exam will be developmental psychology. I took a sample exam this evening and got 33 out of 40 answers correct, so they need to be extremely strict for me not to pass this course, since I am not even done studying yet. On one of the questions I answered incorrectly, however, they probably forgot to insert the word “not” smewhere, since the “correct” answer makes no sense:

Q.: If a three-year-old boy, while watching a video in which he sees himself with a sticker on his forehead, says that he now has a sticker on his forehead, this implies according to Povilleni et al. (1997) that the boy:

1. Objectifies the self;
2. Has difficulty with the grammatical distinction of possessive nouns;
3. Can hardly connect the current self with the self in a previous situation;
4. Doesn’t recognize the discontinuity of the self.

The correct answer was supposed to be C, which is of course complete and utter nonsense: if the child *can’t* connect his current self to himself in a previous situation, he will *not* refer to the video as if he himself is the one wearing the sticker – this is exactly the idea on which research into self-recognition skills is based, stupid. I guessed A, while I’ve never heard of “objectifying the self”, at least not in my dev psych book, but in any case I was certain that C *wasn’t* correct. Going to check whether there’s a correction on the course website.

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Theory-of-Mind Task: Would You Pass It?

Theory of mind is a concept popularized for autism purposes by Simon Baron-Cohen. We are supposed to lack the ability to recognize that other people have a point of view different from our own, while NTs are supposed to be good at taking another person’s perspective. A common illustration of theory of mind involves the Sally-Anne test (or some other names), where one doll, Sally, puts a toy in a box and then leaves the room, another doll, Anne, removes the toy from one box into another, Sally comes back and the child is asked where she will look for her toy. The wrong answer on this test – that Sally will look in the box where Anne put the toy rather than the box she’d left the toy in herself -, is said to mean a child lacks theory of mind. Three-year-old children mostly give the wrong answer, while most neurotypical four-year-olds will give the right answer. Most autistic adults that I know of, by the way, have no problem on this task – but then again, the situations in which we need to sense another person’s point of view become so much more complex as we grow up. Dave Munger of Cognitive Daily, however, writes about a theory-of-mind task even NT adults mostly fail.

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“Quiet Shift!”

I have been reading some nursing blogs lately, and got inspired. As nurses like to note interesting experiences they have with their patients, I like to note interesting experiences I have with nurses. One such experience is the greeting some nurses use to the colleagues when leaving at the change of shift: “Quiet shift!”

This greeting often makes me cringe, because what it mostly appeears to mean is wishing the colleagues a quiet shift for themselves, in other words, that they have little work to do. I don’t know whether this is common in other professions, too, but it strikes me as odd that colleasgues would wish each other little work. What did you get this job for, then?

Of course, it is possible that they mean to wish for there not to be any incidents (like aggression) or significant distress or conflcit among patients during the remainder of the day. This should be positive for patients, too, since who wants to be on a ward when people are constantly showing aggression, having conflicts or in serious distress? The thing is, however, the nurses who most often use this expression, are also the ones who will go to the greatest lengths to be able to sit in their offices doing nothing care-related for the entirety of their shifts. A quiet shift, hence, means a shift in which they are not asked to intervene, rather than a shift that is actually peaceful from the patients’ point of view. Sometimes, this of course coincides, as in, if there are no conflicts and few patients are having relapses of their mental illness, there is generally some peace among the patients and the nurses will be asked to intervene relatively rarely. On these occasions, nurses who are not confined to their office chairs can in fact leave the station and participate in the patients’ leisure activities, which may in turn further reinforce the peace on the ward, because patients are engaged in something other than their particular psychiatric problems.

However, when there is actually distress or conflict, office-confined nurses may keep the peace by simply telling the patients to solve their own problems. Especially on my current ward, which is for resocialization, staff can rationalize this by referring to “independence” and “rehabilitation”. In reality, however, all patients here are still mentally ill and will react accordingly, and we are not trained to deal with each other’s mental illnesses, are we? Besides, should a serious enough conflict for the staff member to have to intervene arise, they will often tell the patients to “come to us”. Yeah, right: we’re supposed to solve our own probelms if we come to the staff, and if we do so and it leads to (verbal) aggression, we’re supposed to have come to the staff earlier. How are we supposed to predict when a situation will escalate, when most of us are unpredictable ourselves and do not know how to deal with unpredictability in others?

Another annoying consequence of the “quiet shift” mantra is that the rules of the ward often don’t matter as long as no-one complains. For example, if someone is playing loud music that is audible for all of his or her floormates, it doesn’t matter that this is against the rules, until or unless someone complains. I had an anooying interaction with a nurse, who is the personification of the quiet shift attitude, a few weeks ago. The guy who sleeps across the hall from me had loud music on while he wasn’t even in his room, and told the nurse that he would be going for a walk outside and the nurse could turn off his music if it was too loud. Having listened to this music all day, I knew without going there that it would be too loud for me to study for an upcoming exam in my own room, so I asked the fellow patient why he wouldn’t turn it off now, if he was going to have a walk outside anyway. He replied in an agitated voice that he wanted to hear the music from outside when he was coming back – I guess portable radios have existed for at least twenty years, but oh well -, and that he had a right to like music as I like computers (but then again, my computer isn’t audible across the entire ward). The nurse at that point intervened, telling me not to involve myself in the matter since I wasn’t upstrairs anyway, and, when I said that I was going there soon, he said that I should go up to him to turn off the music then. A few minutes later, I did want to go study in my room, so I asked the nurse to turn off the music. His response: “Try if you can study first, and if the music is too loud, come downstrairs again and I’ll go turn it off.” Oh my! Quiet shift. Yeah, right.

Of course, the annoying thing about nurses who do monitor patients’ behavior strictly rather than just sitting in their office until someone comes to pull them out, is that they will notice and may react to tiny distortions from “normal”, but at least with the strict, monitoring nurses, you know that they will stick to the rules they themselves set. Ideally, of course, a nurse has just the right mix of involvement and flexibility to let patients solve their own problems when they can and intervene when they should.

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Texas Mistreats Its Developmentally Disabled Citizens

I heard about the mistreatment and abuse of Texas developmentally disabled people already several months ago, when the “fight club” mistreatment was first reported. Now that the man who initiated the thing has been sentenced to three years in jail, and after 288 employees of state facilities have been disciplined for mistreatment or abuse, John M. Grohol of World of Psychology writes a post about it again. In particular, he criticizes the fact that the “fight club” had been going on for over a year, and was only discovered because someone accidentally lost his mobile phone and someone else turned it in to the police. He writes:

I’m sorry, but the Commissioner of the Texas Department of Aging and Disability Services, Adelaide (Addie) Horn, should offer her resignation. How could this be happening on your watch – for over a year – and you have no idea it’s going on? How could you oversee a department where 8 percent of your employees
are fired or disciplined for mistreating or outright abusing the people you’re tasked with caring for?

I am tempted to agree. If you don’t know what happens in the facilities for which you are responsible, and these facilities happen to house some of the more vulnerable people in your state, you shouldn’t be having this job. People’s health and possibly even lives are at stake in this situation. The wellbeing of the disabled shouldn’t be dependent on the possibility that someone loses his cellphone.

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No Psychiatric Care in Juvenile Prison

John M. Grohol of World of Psychology comments on the lack of mental health services for juvenile prisoners. Juvenile criminals, of which a great number have one or more mental illnesses and/or substance abuse and are on psychotropic drugs, receive few or no mental health care. It didn’t surprise me, however sad this is. In the Netherlands, this has been known for years: even though most inmates in the juvenile system have mental disorders, there is only one juvenile prison employing a child psychiatrist, part time. Staff, rather than being trained to work with children with serious problems, come from all walks of life and all types of education or the lack thereof. To make matters worse, here, there are about 1,000 children nationwide in prisons who don’t even have a criminal record, but merely have serious behavioral or psychiatric disorders and no place in child psychiatry. This will be illegal from 2010 on, but I don’t think there will be enough child mental hospitals by then to help all of them. I’m pretty sure that in this economic crisis, the government has other priorities.

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Partial-Birth Abortion: Could the Term Be Misleading?

While browsing pro-life blogs, I stumbled upon a post about partial-birth abortion. For those who don’t know what this is: it’s an abortion procedure by which the unborn baby is partly delivered and then the skull is crushed. In medical jargon, this procedure is also called intact dilation and extraction (IDE), which is in my opinion more elusive than partial-birth abortion, due to its complete and utter vagueness – one can’t even tell from its name that it’s an abortion procedure.

However, the writer of the post I linked to above, is incorrect to assume that there is no possibility for misleading in the term “partial-birth abortion”. I myself used to misunderstand the term until I looked it up on Wikipedia when using this procedure as a pro-life argument against my pro-choice family. Until that point, I had erroneously assumed that “partial birth” means the baby is pretty close to being due at the point of extraction. “Birth”, after all, in the common definition, refers to something that takes place at ideally forty weeks gestation, and not at a point at which the baby isn’t viable (ie. today at its very earliest at 22 weeks). While technically this possibility exists and is being used in some countries (eg. the UK with its extremely liberal abortion law), in reality, this procedure is being used from the sixteenth week of pregnancy on, at which point babies aren’t going to be viable anytime soon. It is, for me, no reason to take a different stand on the issue, since I don’t support abortion at sixteen weeks, either, and the method makes no difference. However, to a pro-choicer who is being persuaded towards a more pro-life opinion by graphic abortion details, this misconception may well be important. Of course, some pro-life apologetics wouldn’t care how we convert pro-choicers as long as we do, but I for one do care. After all, if we misinform pro-lifers-to-be and they find out, we may well lose them on our side again. I would never have been able to convince my family to take even a slightly more pro-life standpoint anyway, but it wasn’t a good demonstration of my debating skills that I had to admit that I’d been using incorrect information in my arguments.

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Preschool Depression: The Latest Fashion in Child Psychiatry

Philip Dawdy at Furiosu Seasons wrote a psot last week criticizing the idea that preschoolers get chronic depression. After ADHD, autism and pediatric bipolar, this is probably the next child psychiatry hype big pharma is eagerly profiting from. Note that I’m not saying that these disorders don’t exist – ADHD and autism certainly do and I know too little about pediatric bipolar to decide either way. I’m also not saying that certainly children in preschool cannot be depressed – I think some, in unfortunate circumstances, do experience real depression. However, one goes too far when assuming that any child in a chronically unhappy state must have a chemical imbalance. Many actually live in unfavorable circumstances – today’s society is not as child-friendly as it was several decades ago -, and a few may actually be diagnosed with a disorder when the same behavior used to be accepted as normal (again, we have had this with many other psychiatric disorders of childhood). Above all, antidepressants have possibly nasty side effects and I have no clue whether any long-term research on the effect of these drugs on neurodevelopment has ever occurred. If a preschool child genuinely experiences depression, non-pharmcacological treatments should be used.

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Comments on Autism and Medication

I went over to Laura at Touched By an Alien: Life as I Know It to submit my disability blog carnival posts – which didn’t work -, and stumbled upon a June 23 post of hers, called Medication and the Autism Spectrum. In this, she writes:

It is always a balance between having the lowest risks possible and the best possible quality of life. For instance an individual with Asperger Syndrome that is “medication free” but having public meltdowns is not acceptable, nor is an individual who is on such a high dose of medications that the side effects have serious impact on their quality of life.

I am bothered by this comment, and not because I either think that meltdowns are acceptable, or that someone who is having public meltdowns must be getting poor support. As much as I have experienced the negative impact poor quality care has had on my behavior, I also know that there are people, myself included, who may have meltdowns despite the best possible care available to them within the limits of an inevitably flawed system. What, however, bothers me, is the suggestion that medications would solve such problems in any situation.

I was in fact struck by Laura’s very first sentence in the post, which asserts that advances in psychopharmacology have made it possible for many Asperger’s people to have a better quality of life. My surprise did not come from some neurodiversity mantra that says medications are wrong regardless, but from the fact that, to my knowledge, only one drug (Risperdal, spelled incorrectly by Laura) has been approved for anything related to autism at all, ie. irritability. If an autistic’s main problem happens to be irritability, and Risperdal doesn’t work, or causes intolerable side effects, what else have we left? Of course in daily practice, most other atypical antipsychotics are being used, but there is little if any scientific evidence to support their effects. And if an autistic has intolerable obsessive-compulsive behaviors, they might’ve been put on Celexa, but a recent study found this drug to be ineffective in this population.

And even if we accept common practice as the standard rather than science, there are still a considerable number of psychiatrists who maintain that medication should not be used as a primary treatment method for autism, due to its dubious effects and the increased risk of side effects and/or paradoxical reactions. I was myself told by my GP that she did not want to increase my Risperdal (she did not recommend a decrease, either, even though I was having no positive effects and some side effects), and the two psychiatry residents who ever talked to me about drugs, were probably reprimanded by their supervisors, as they wouldn’t even get back to me to tell me they’d been wrong to discuss the matter at all. And in all of these cases, it wasn’t because I was not having meltdowns in public – in fact, I was, so much that I needed to be on the locked ward with no privileges at one of these times. Of course, if they used any logic at all, it was the wrong one – that is, I had a behavior disorder that I just needed to control (and controlling my behavior meant I wasn’t feeling overwhelmed anymore). However, if they’d just used the correct logic, they could’ve been right: there are no drugs “for autism”.

Honestly, really, sometimes I’ve envied people who have had success with Risperdal. I didn’t like the side effects and I think it was ridiculous that I had to embark on this journey into independent living at that point at all, but I’d much rather not have had my crisis if I had the choice. If my doctor had actually found that I was having withdrawal symptoms in November of 2007 – again, this was the first psych resident who suggested this and never got back to me about the topic at all -, I would likely have gone back on the drug. The thing is, this was either not thought likely or the doctor found that the whole idea of putting me on an antipsychotic had been ridiculous in the first place – and this wouldn’t have been because I was fine without meds. I was NOT.

Maybe this wasn’t what Laura meant to suggest, but to me, the assertion about a “med-free” Aspie with public meltdowns being unacceptable, incorrectly connotes that if that Aspie just took some drug, they wouldn’t be a burden to society as much as they are now. Of course, if Laura just refers to autistics who are principly opposed to drugs, and who hold this view because they think the world should just accept that they’re having huge screaming and hitting fits in shopping malls, I can see her point – yet then again, I’ve never met a person who actually has an attitude like this -, but if she means any autistics who are not on medication and still having public meltdowns, she really lacks some important knowledge.

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