Left Brain Right Brain

June is the season of graduations. It is also the time for Father’s Day (at least in the U.S.), which occurs this Sunday. Around this time we see a lot of ads for “Dads and Grads”, mostly by people selling greeting cards and presents.

I’d like to send out congratulations to the grads out there. I’d like to send out a good word to fellow Dads out there. I hope Sunday is a great day for you.

I’d really like to take the opportunity to single out: autistic grads and autistic dads. Autistic grads: congratulations. I was reminded of the “dads and grads” season by the story of an autistic graduate who is absolutely one of my heroes. I’ve never met the person, but that person inspires me in ways I never knew possible. Autistic dads: I’ve “met” some of you online, here and elsewhere. I’ve spoken to some of you on the phone and in person. I wish you all an especially good father’s day.

Autistic moms: sorry I missed a message for Mother’s Day. Completely an oversight on my part as you are also a great inspiration to me.

Use of school recess time in the education and treatment of children with autism spectrum disorders: A systematic review is, as you will see, a small study on what is a relatively unstudied area: recess as part of the educational day for autistic students. This caught my eye for a simple reason: I think a lot about recess. I think about special education kids, kids who are working really hard, who need the break that recess provides as much or more than anyone.

Here is the abstract:

School recess is an opportunity to include students with autism spectrum disorders (ASD) with their typically developing peers and is a setting in which instruction can occur. However, the educational opportunities for children with ASD within recess are often overlooked and recess time is being reduced or eliminated in the United States. This review involved a systematic search and analysis of 15 studies that utilized recess to implement academic, social, or behavioral interventions for students with ASD. Each identified study that met pre-determined inclusion criteria was analyzed and summarized in terms of: (a) participant characteristics, (b) intervention procedures, (c) dependent variables, and (d) intervention outcomes. This review has three main aims: (a) to evaluate and synthesize the evidence-base, (b) to inform and guide teachers interested in utilizing recess time for educational purposes, and (c) to stimulate and guide future research in this area. Results demonstrate that recess time can indeed be used to teach target behaviors to students with ASD.

Here is the first part of the conclusion

Systematic search procedures identified 15 studies that used recess time to deliver intervention to preschool and elementary school students with ASD. Summaries of the studies revealed that a variety of different interventions have targeted a range of behaviors including challenging behavior, social skills, play, and communication. The most common dependent variables were social skills, and the most common intervention component involved typically developing peers serving as models of target behavior or as therapists with an active role in prompting and reinforcing target behaviors (e.g., McGee et al., 1992). Overall, the existing literature base is perhaps best described as limited given the paucity of studies and the relatively low number of participants (N = 46). However, despite these limitations several important points do emerge.

Baseline levels of dependent variables across the included studies demonstrate that, prior to intervention, students with ASD engaged in high levels of stereotypy and challenging behavior and low levels of appropriate play and social interaction. Therefore, unlike typically developing students who benefit simply by being given access to recess (e.g., Pellegrini & Smith, 1993), students with ASD may need additional supports in order to benefit form educational and social opportunities on the playground ([Lang et al., 2009a], [Lang et al., 2009b] and [Lang et al., 2009c]). Consequently, if a student lacks the skills necessary to meaningfully participate in recess, goals and objectives related to recess should be included in their individualized education plans.

OK, even as a review, where they pool data from multiple other studies, this is small: 46 participants.

The authors note that (a) recess is important for kids, especially younger children and (b) recess time seems to be declining in general (possibly due to the no child left behind laws in the U.S.).

I really have to pose the question: how much is recess valuable precisely because it is self-directed time? How do you define if “a student lacks the skills necessary to meaningfully participate in recess”? If a typical child spends recess in a corner of the playground reading a book or doing homework, is that a meaningful participation in recess? If an autistic kid needs that time to blow off steam in some other way, is that “meaningful”? Who defines “appropriate play”? If a child, say, spends recess screaming–is that “inappropriate play” or is that a sign that the classroom environment may be overstressing the child? Sure, if a student has the desire, but not the skills, to use recess for social interaction, let’s see about supporting that. If a child enjoys working on play skills, again. But I have a bit of a reservation about making recess into more time for work.

Last December I wrote about my search for a good recorder for IEP meetings. I’ve had a little experience since, and I thought I would offer that.

I have now used 2 solutions. First, an iPod touch. Second, a Tascam DR-05.

The iPod touch was much more useful than I expected. It was handy. I had to put it in the corner of a fairly large room (in order to be near a power outlet) and I still got reasonable clarity. There are no settings on the iPod touch, just start and stop. What bugs me is that once the screen turns off, there is no feedback that the recording is going on. Also, I tend to fidget with the iPod during meetings (looking at pictures of my kid primarily). Not ideal if it is the recorder.

I’d like to say that the second solution, the DR-05, came after much comparison of features and quality. Instead, it came from a brief visit to the local Guitar Center. The staff were friendly, but unable to tell me anything that wasn’t obvious (like price, size, number of microphones, memory…).

Here are some features that work well for me with the DR-05:

A lot of space using the least compressed mp3 format (about 12 hours). I am paranoid of running out of storage. I also dread the fatigue of listening to over compressed sound for hours while transcribing. If I could feel comfortable about capacity, I’d use .wav format files.

Easy controls. Once the basic settings are in place (such as mp3 vs. wav, audio levels, etc.), the DR-05 is very easy to use. Push the on button and it boots in about 5 seconds. Hit record once to see levels. Hit again to start. Hit stop to finish. The only thing that worries me is the possibility of leaving the recording in the initial pause state where you check the levels. This brings up the next feature I like:

A little red light that shows it is recording. This is what bothered me about the iPod. I worry about getting to the end of a meeting and finding that the recording stopped for some reason and I didn’t know. With the DR-05, this isn’t a problem.

The DR-05 is a not the smallest recorder, and not the cheapest (at about US$100). The buttons are easy to use for me, and that beats a smaller size. Without the batteries it feels like a cheap plastic shell. Yes, much of the heft of the device is 2 AA batteries.

I put fresh batteries in before a meeting, so I can’t speak to the battery life other than it is more than sufficient.

Recordings can be transferred by a USB cable. Also, you can listen directly to the DR-05 with headphones (or with the built in, tiny and quiet speaker. I’d not recommend that for transcription, though). There is a feature to loop or to go back a set period of time (between 5 and 30 seconds, user settable) which makes transcriptions easier.

The sound quality was reasonable. I have to see if there are any important statements missed in the noise.

I considered using a netbook, with or without an external mic. This has the advantage that I already own them. But it seemed cumbersome and, well, a bit odd. The Tascam is big enough without being obtrusive. The iPod was OK, and I expect most smart-phones would do the job. I just find the worries I listed above to be enough to warrant spending the $100 on the dedicated recorder.

In a recent paper purporting to link autism and vaccines, the author, Gayle DeLong, chose to lump autism and speech or language impairments together to create an autism “prevalence” from special education data:

To determine autism prevalence by U.S. state, the number of 8-year old students classified with either (1) autism or (2) speech or language impairments (speech disorders) was divided by the total number of 8-year-olds in the state.

The author has defended the choice over at the Respectful Insolence blog:

Orac,
I won’t respond to the personal attacks, but I will correct one error. The Herbert reference in the paper is incorrect. The correct citation is: Herbert and Kenet (2007) Brain abnormalities in language disorders and in autism. Pediatr. Clin. North Am. 54:563-583 (abstract: http://www.ncbi.nlm.nih.gov/pubmed/17543910). The paper shows that brain injury of people with autism is similar to brain injury of people with speech and language disorders. Another paper that makes much the same point is Herbert et al. (2002) Abnormal asymmetry in language association cortex in autism. Ann. Neurol. 52:588-596 (abstract: http://www.ncbi.nlm.nih.gov/pubmed/12402256).

Speech impairment is such a fundamental symptom of autism that the two conditions cannot be separated, especially when the child has a speech/language impairment that is strong enough to be classified as a learning disability.

First, kudos to Ms. DeLong for taking her statement to Orac’s blog. The participants are clearly not supportive of her statements–such as:

“Speech impairment is such a fundamental symptom of autism that the two conditions cannot be separated, especially when the child has a speech/language impairment that is strong enough to be classified as a learning disability.”

All I can say is that I disagree. Strongly.

Here is the definition that California uses for Autism as a special education category:

56846.2. (a) For purposes of this chapter, a “pupil with autism” is a pupil who exhibits autistic-like behaviors, including, but not
limited to, any of the following behaviors, or any combination thereof:
(1) An inability to use oral language for appropriate communication.
(2) A history of extreme withdrawal or of relating to people inappropriately, and continued impairment in social interaction from
infancy through early childhood.
(3) An obsession to maintain sameness.
(4) Extreme preoccupation with objects, inappropriate use of objects, or both.
(5) Extreme resistance to controls.
(6) A display of peculiar motoric mannerisms and motility patterns.
(7) Self-stimulating, ritualistic behavior.
(b) The definition of “pupil with autism” in subdivision (a) shall not apply for purposes of the determination of eligibility for
services pursuant to the Lanterman Developmental Disabilities Services Act (Division 4.5 (commencing with Section 4500) of the
Welfare and Institutions Code).

One can not say that SLI and autism are directly linked.

The data don’t support it either. Her own paper gives administrative prevalence numbers for autism+SLI which are as high as 10%, about a factor of 4-10 than reported for autism.

Also, consider this: if you look at the administrative prevalence of SLI with age in a given year, it is sharply peaked at around age 6 or seven. Here are the data for SLI and autism from the most recent year data are available in California. (click to enlarge)

(note–when this was first published, the graph was not in color).

No, that isn’t a “tidal wave” of SLI. This is what SLI looks like every year. It is a category mostly for younger children. I’ve often wondered if many of these children end up in the specific learning disability category in later years as this category is largely made up of older kids. Either way, it is clear that children tend to leave the SLI category, and they certainly aren’t being reclassified as autistic. Clearly, SLI is not something which can not be separated from autism.

I don’t know why Ms. DeLong chose to lump autism and SLI together for her study. I do feel quite strongly that the idea that they are basically the same is incorrect.

I read this phrase often on the web: vulnerable parents. Usually in some discussion of families involved in alternative medicine or vaccine causation. It’s a phrase that bothers me.

I have to say that I find the phrase very odd. Odd as in it is redundant. To be a parent by definition is to be vulnerable. Every time we make connections to others, be they children, spouses, friends, heck even pets, we make ourselves vulnerable. Of course we feel pain when a loved one suffers or is in pain.

If you’ve ever spent the night in the ER with a kid with a broken arm, you know what I mean. Worse in many ways is to be the one at home while your kid is in the hospital, waiting for messages.

We are all vulnerable. Parent or no. Need I say it: autistic or no.

Vulnerable parent. That phrase has no meaning for me.

It is how we deal with our vulnerabilities that defines us. And I believe that’s what people really mean when they say “vulnerable parents”: parents who make choices they probably wouldn’t if they weren’t influenced by their love of their children.

There’s a whole spectrum of ways people respond to their vulnerability. And, yes, for some parents of autistic kids that involves being susceptible to some very questionable and poorly supported ideas. But it’s too simplistic to attribute this to “vulnerable” parents. We all are vulnerable.

Here is a really, really small study. But the idea to me is very cool. Using the iPod touch (the little brother to the much discussed iPad) to teach children with developmental disabilities to listen to music. The authors worked with only three children (really small), and used video modelling to show kids how to use the iPod touch.

The idea of a simplified, visual operating system like that on the iPod and the iPad is an amazing step forward. A simple task like choosing one’s own music can be a big step forward in independence, if you ask me.

Teaching students with developmental disabilities to operate an iPod Touch(®) to listen to music.
Kagohara DM, Sigafoos J, Achmadi D, van der Meer L, O’Reilly MF, Lancioni GE.
Source

Victoria University of Wellington, Wellington, New Zealand.
Abstract

We evaluated an intervention procedure for teaching three students with developmental disabilities to independently operate a portable multimedia device (i.e., an iPod Touch(®)) to listen to music. The intervention procedure included the use of video modeling, which was presented on the same iPod Touch(®) that the students were taught to operate to listen to music. Four phases (i.e., baseline, intervention, fading, and follow-up) were arranged in accordance with a delayed multiple-probe across participants design. During baseline, the students performed from 25 to 62.5% of the task analyzed steps correctly. With intervention, all three students correctly performed 80-100% of the steps and maintained this level of performance when video modeling was removed and during follow-up. The findings suggest that the video modeling procedure was effective for teaching the students to independently operate a portable multimedia device to access age-appropriate leisure content.

Here is a paper I found looking for the link to the above study
Three Students with Developmental Disabilities Learn to Operate an iPod to Access Age-Appropriate Entertainment Videos

Again, small. I haven’t looked through to see how good the study is. I’m just glad to see this technology being investigated like this at this point.