|Autism Symposium: Basic Science Panel |
Panelists: Drs. Rajadhyaksha, Casey, Lee,
Walkup, and Dr. Barry Kosofsky,
who convened the symposium, at podium.
Given this happy convergence of the informational and the intimate, I was delighted to report on the Autism Symposium again. Appropriately enough for a day focused on autism and transitions, anxiety seemed to be the watchword for the day. As anyone who lives on or near the autism spectrum knows, there is a fundamental autistic axiom that governs our lives: change is bad. Since life is pretty much ever-changing, this creates a whole array of challenges for us. The first panel of the day looked at basic science and generated insights into why anxiety is such a foregrounded feature in our lives on or near the spectrum.
"anxiety anomalies": Although Dr. BJ Casey's presentation focused on adolescence, and how the emotional and regulatory centers of the brain develop at different rates creating the volatility characteristic of teens, the big takeaway for me from her research is that treatments that work for neurotypical individuals may not work at all for autistics. In fact they might be incredibly damaging.
|From Dr. Casey: Atypical development is |
associated with less emotional regulation.
(If you're interested in reading her team's original research on this you can find Casey's publication on this online.)
So let's think about Casey's findings. Say that you're autistic and you're terrified of dogs, as our girl once was. If we had treated this with exposure therapy (a widely respected treatment for phobias that gradually but repeatedly exposes you to whatever frightens you) then it's highly likely that we would have done a bang-up job of creating a super-phobia in our child.
Just imagine if our girl had been misdiagnosed as having a phobia. Imagine we had pursued exposure therapy. Or worse yet, that we engaged in the non-therapeutic parental version of exposure therapy: "You just have to get over this -- just pet the damn dog!" I shudder to think how that might have worked out. By respecting our girl's terror as genuine, and treating her general anxiety with a pharmacological intervention, we now have a girl who'd love to have her own dog.
"anxiety across diagnoses": The importance of getting the diagnosis right was underscored in Dr. John Walkup's analysis of the various multiple diagnoses (or co-morbidities) that are often assigned to ourselves or our children. Walkup described the diagnostic process as having two opposing tendencies: "lumping" vs. "splitting." "Lumpers" aim to pull together characteristics to form a category while "splitters" tend to look for the specific or distinctive characteristics of a syndrome, disease, disorder or difference. Without accurate diagnoses, Dr. Walkup asserted, one winds up treating symptoms: melatonin may work to treat insomnia, but you might be better off treating the underlying anxiety that's keeping a child awake.
|From Dr. Walkup:|
Diagnostic trends can create clusters or move
toward greater specificity.
We were fortunate in that her psychiatrist took the initial decision to go the splitting route: the original three diagnoses he provided (ADD, GAD, and mixed expressive-receptive language disorder) entitled her to insurance coverage that would not have been available had she been cast as developmentally-disabled. Things have changed now that insurance coverage of autism treatment is mandated, but that original split set of diagnoses got our girl the best possible combination of psychopharmacological, behavioral, and educational interventions.
"anxiety in adolescence": We're a long way from our own early diagnostic days, and with adolescence upon us, the work of Dr. Francis S.Y. Lee on anxiety in adolescence was of particular interest. Dr. Lee's presemtation concerned the ways that in typical adolescent development there seem to be developmental mechanisms, probably at the molecular level, to repress or mute fear response. Evolutionary biologists think these mechanisms exist to assist adolescents in taking the risks necessary to set out on their own. During such periods of fearlessness (when fearful memories seem to be repressed) the adventures that lead to adulthood can take place. (Or disasters can occur, but let's hold that for another day.)
Extrapolating from mouse models, Lee hypothesizes that there are sensitive periods in adolescence when windows of fear-memory suppression may provide opportunities for pharmacological or behavioral interventions (to re-tune the fear response that is otherwise atypical in individuals with anxiety disorders and ASD). Specifically, interventions that raise BDNF (brain derived neurotropic factor) levels may impart beneficial effects on attenuating the fear memory retrieval, and thus alleviate anxiety among the hyper vigilant.
|From Dr. Lee: Adolescence is marked by periods of low|
fear response, as shown in this table based on
laboratory work with mice.
Dr. Lee's research, along with the transitional model for drug discovery described by Dr. Anjali Rajadhyaksha, hold out the possibility of new treatments. Instead of simply reducing excessive anxiety with ongoing medication, new medications might modify the chemical mechanisms that make anxiety so dominant in autistics and their families.
When our girl was dog phobic, we used to cross the street whenever someone was walking a dog. After a while, we didn't even like going out. Lots and lots of people walk dogs in New York City – in fact, they're nearly impossible to avoid. But thanks to interventions that reduced her anxiety, now we have a happier problem: looking for a dog tiny enough for our apartment or an apartment big enough for our a growing girl and a dog.
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