https://www.dailycal.org/2018/04/12/compulsion-complexity
Showing posts with label BioPhysical Health. Show all posts
Showing posts with label BioPhysical Health. Show all posts
Accounting for Sensory Sensitivities and Communication Methods
"There may be apprehensions about whether positive psychology interventions can be effectively tailored to meet the unique and varied needs of all autistic individuals, considering our diverse sensory sensitivities, communication methods, and personal preferences." - Hari Srinivasan
Genetic Differences Between Autism and ADHD—and Why It Matters
Genetic Differences Between Autism and ADHD—and Why It Matters
On the surface, autism and ADHD might look like they share some overlapping behaviors, especially in areas like attention and impulsivity. But beneath those similarities, the genetic research on each reveals fundamental differences. And with more people receiving both diagnoses (often called AuDHD), genetic research is starting to explore how these conditions interact in the same person.
ADHD: A Focus on Dopamine and Attention
One of the most consistent findings in ADHD research is the role of dopamine, a neurotransmitter that helps regulate attention and motivation. ADHD individuals often have differences in dopamine pathways, making it harder to focus and control impulses. Genetic research has honed in on genes like DRD4 and DAT1, which impact dopamine receptors and transporters, the mechanisms that manage dopamine levels in the brain. This focus on dopamine has led to effective ADHD treatments, such as stimulant medications that boost dopamine. But these meds don’t always work the same way in autism.
Another big area in ADHD genetic research is polygenic risk—the idea that many small genetic variations combine to raise ADHD risk. By studying these variations together, researchers are building genetic “risk scores” to better understand each person’s overall predisposition to ADHD.
Autism: A Complex Web of Genes
Autism, in contrast, has a more diverse genetic landscape. Autism genetics doesn’t just focus on one system like dopamine; it spans pathways involved in synaptic development (how brain cells connect) and sensory processing. Genes like SHANK3 and CHD8 are heavily studied because they’re critical for neuron communication, affecting social interaction and sensory integration.
Autism genetics includes both polygenic influences and rare, single-gene mutations. This mix shows that autism isn’t a “one-size-fits-all” condition and involves a wide range of genetic influences—making autism research complex but incredibly informative.
Why ADHD Medications Don’t Always Work in Autism
Since ADHD and autism have different genetic roots, treatments that work well for ADHD may not work the same way in autism. For example, stimulants boost dopamine levels and are effective for ADHD, but autism involves additional neurotransmitter systems like GABA and glutamate. For autistic individuals, boosting dopamine may not address their primary challenges and can even lead to side effects like increased anxiety or sensory sensitivity.
This phenomenon, called differential drug response, is why treatments need to be tailored more closely to each condition.
The Overlap- Understanding AuDHD
Many autistics also meet the criteria for ADHD, and research suggests they experience a unique blend of traits. Genetically, there are overlapping patterns, particularly in dopamine, serotonin, and synaptic pathways. This shared foundation is prompting researchers to think of autism and ADHD as conditions that can intersect within the same person, rather than existing in isolation.
Understanding the unique profile of AuDHD could reshape how we approach treatment. Right now, genetic testing and treatments for autism and ADHD often operate in silos, leading to medications being prescribed without considering their impact on combined traits. A focus on AuDHD could lead to integrated approaches that tailor interventions to address overlapping needs.
Bringing It All Together
In summary, ADHD genetics zeroes in on dopamine-related genes that influence attention and impulsivity, while autism genetics explores a wider range of genes involved in synaptic function, sensory processing, and neurodevelopment. For those with AuDHD, understanding these combined influences can lead to support and treatments that don’t just fit the condition but fit the individual.
This is the future of neurodevelopmental treatment—a future where we move from “one-size-fits-all” to “one-size-fits-one.”
Exclusion of those with more complex needs
"Key concerns.... oversimplification of needs and the potential exclusion of those with more complex challenges when focusing solely on strengths and well-being. This approach risks neglecting the intricate support required by many on the spectrum. " - Hari Srinivasan
"We must dispel the notion that any medical intervention is inherently harmful. Many autistic peers I know experience chronic sleep deprivation, multiple seizures, pain, autoimmune conditions... spend the entire night on the toilet due to gut issues... engage in intense self-injurious behaviors, aggressive behaviors, and frequent meltdowns, which leave them home-bound. Living in a state of chronic unwellness is not conducive for inclusion. The quality of life for such autistics is challenging, no matter what kind of societal supports (inadequate as they are currently), or opportunities are put in place for inclusion."
- Hari Srinivasan, Newsweek
Challenges-Based Solutions
"For some autistics, we can step right into the application of positive psychology. For others, we need to be working on challenge-based solutions at the same time. It’s not a binary, either/or situation where you do one at the expense of the other. " - Hari Srinivasan
https://www.liebertpub.com/doi/10.1089/aut.2024.38246.pw
Diagnostic Overshadowing
"Autism already faces the problem of diagnostic overshadowing where anything and everything is attributed to the mysterious bucket of “it's all part of autism so live with it, nothing more need be done,” by medical professionals. Ironically, the same underlying issues would get treated if the autism label were not attached to that person."
- Hari Srinivasan, Newsweek
Autism Cares Act 2024 Reauthorization
Key Highlights of the Autism CARES Act of 2024:
https://www.congress.gov/bill/118th-congress/senate-bill/4762/text
Reauthorization and Amendments:
These funding priorities aim to support comprehensive research, early detection, intervention, and coordination of services for individuals with autism spectrum disorder
Reauthorization and Amendments:
- The bill reauthorizes programs and research related to autism under the Public Health Service Act until 2029.
- It includes amendments to improve the language and scope of existing provisions, such as changing "culturally competent" to "culturally and linguistically appropriate."
- Extends the program's authorization to 2029.
- Updates terminology to be more inclusive and accurate.
- Emphasizes culturally and linguistically appropriate services.
- Expands the scope to include both screening and diagnostic services.
- Promotes research on evidence-based practices and interventions.
- Requires a report on the need for developmental-behavioral pediatricians and the feasibility of expanding training programs.
- Requires annual summaries and biennial updates on activities.
- Extends the committee's authorization to 2029.
- Updates the timeline for required reports to 2024.
- Adds a requirement for a report on young adults with autism transitioning to adulthood.
- Expands research areas to include psychiatry, psychology, gerontology, and other relevant fields.
- Requires the NIH Director to consider the various needs of individuals with autism, including co-occurring conditions.
- Mandates an annual budget estimate for autism research initiatives.
- Allows the Secretary of Health and Human Services to provide training and technical assistance on using federal funds for communication tools for individuals with autism.
- Requires an annual report on the technical assistance provided and advancements in communication tools.
- Developmental Disabilities Surveillance and Research: $28,100,000 annually for fiscal years 2025 through 2029.
- Autism Education, Early Detection, and Intervention: $56,344,000 annually for fiscal years 2025 through 2029.
- Interagency Autism Coordinating Committee and Related Activities: $306,000,000 annually for fiscal years 2025 through 2029.
These funding priorities aim to support comprehensive research, early detection, intervention, and coordination of services for individuals with autism spectrum disorder
Misunderstanding that autistics with higher support needs do not experience mental health issues.
"Accessibility and inclusivity of positive psychology interventions is limited across the spectrum, particularly for the most marginalized members… A critical misunderstanding that exemplifies these issues is the misconception that autistics with higher support needs do not experience mental health issues. This not only excludes a significant portion of the autistic population from mental health initiatives but also from the benefits that positive psychology can offer, highlighting the urgent need for more inclusive and accessible practices in this field." - Hari Srinivasan
https://www.liebertpub.com/doi/10.1089/aut.2024.38246.pw
Understanding Neurophysiological and Neurobiological Perspectives in Autism
When discussing autism, we often focus on behaviors—how someone communicates or interacts with others. However, to truly understand autism, it’s important to look deeper into the brain's functioning. Neurophysiological and neurobiological perspectives offer insights into the brain's activity and structure in autism.
Neurophysiology: The Brain in Action
Neurophysiology refers to the study of the brain's electrical and chemical processes. In simpler terms, it looks at how the brain functions in real time. For autistics, neurophysiology can explain why sensory experiences might feel more intense or overwhelming. Research using EEG has shown that autistic brains often respond differently to sensory stimuli, with variations in brain wave patterns that suggest heightened sensitivity or delayed processing . This difference in neural activity can contribute to sensory overload and the need for certain sensory accommodations.
Neurobiology: The Brain's Structure and Development
Neurobiology, on the other hand, examines the brain's physical structure, development, and genetics. It looks at the brain's "hardware"—its neurons, synapses, and the genes that influence its development. In autism, neurobiological studies have found variations in brain regions involved in social behavior and emotion processing, such as the amygdala and prefrontal cortex . These differences can affect how autistic individuals perceive and respond to social stimuli, contributing to the diverse range of social behaviors seen in autism.Genetic research also plays a significant role in neurobiology. Many studies have identified genes associated with autism, highlighting the genetic underpinnings that contribute to brain development and function . These insights are crucial for understanding the diverse expressions of autism and for developing personalized approaches to support autistic individuals.
Bridging Neurophysiology and Neurobiology
Combining neurophysiological and neurobiological perspectives provides a more comprehensive understanding of autism. For example, if an autistic person has a neurobiological difference in the connectivity between brain regions involved in emotion processing, this might lead to a neurophysiological response that is heightened or atypical when encountering emotional or social cues.
References
- Orekhova, E. V., Stroganova, T. A., Nyström, P., & Gillberg, C. (2006). Excess of high frequency electroencephalogram oscillations in boys with autism. Biological Psychiatry, 62(9), 1022-1029.
- Schumann, C. M., & Amaral, D. G. (2006). Stereological analysis of amygdala neuron number in autism. Journal of Neuroscience, 26(29), 7674-7679.
- Geschwind, D. H. (2011). Genetics of autism spectrum disorders. Trends in Cognitive Sciences, 15(9), 409-416.
Stress Anxiety and Autism
Stress and anxiety are often used interchangeably, but from a scientific perspective, they are distinct concepts that involve different physiological and psychological processes.
What is Stress?
Stress is the body’s response to any demand or challenge, which can be physical, emotional, or psychological. It’s a natural reaction to specific stressors like an upcoming exam, a work deadline, or even a physical threat.Types of Stress:
- Acute Stress: This is a short-term response to an immediate threat or challenge, often referred to as the "fight or flight" response. During acute stress, the body releases hormones like adrenaline and cortisol to prepare for action.
- Chronic Stress: This occurs when stressors persist over a longer period, leading to a prolonged stress response. Chronic stress can negatively impact physical and mental health, increasing the risk of cardiovascular diseases, depression, and anxiety disorders.
What is Anxiety?
Anxiety, on the other hand, is a psychological state characterized by feelings of worry, nervousness, or fear that are typically disproportionate to the actual threat or challenge. Unlike stress, which is a response to an external stressor, anxiety often persists without a clear or immediate cause.Types of Anxiety:
- Situational Anxiety: This is a normal response to a stressful situation, such as public speaking or taking a test.
- Anxiety Disorders: These are mental health conditions where anxiety is excessive, persistent, and interferes with daily life. Examples include generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, and specific phobias.
Key Differences Between Stress and Anxiety
- Trigger: Stress is typically a response to a real, identifiable stressor, while anxiety may not have a clear trigger and is often more generalized.
- Duration: Stress can be acute or chronic, depending on the presence of the stressor. Anxiety tends to be more persistent and can exist even in the absence of stressors.
- Physiological Response: Both stress and anxiety can activate similar physiological responses, but anxiety often includes a more significant cognitive component focused on worry and fear about potential future events.
- Adaptiveness: Stress can be adaptive and helpful in certain situations by preparing the body to handle a challenge. In contrast, anxiety, especially when excessive or disproportionate, can be maladaptive and debilitating.
The Intersection of Stress, Anxiety, and Autism
For autistics, the experience of stress and anxiety can be more pronounced and complex. Autistics often face unique stressors, such as sensory overload, social challenges, and difficulties in communication. These stressors can contribute to both acute and chronic stress. Additionally, anxiety is highly prevalent among autistic people, with studies suggesting that up to 40% of autistics may also have an anxiety disorder.
Why Are Autistic Individuals More Vulnerable to Stress and Anxiety?
- Sensory Sensitivities: Many autistic individuals have heightened sensory sensitivities, which can make everyday environments overwhelming. This constant bombardment of sensory input can lead to chronic stress and anxiety.
- Social Challenges: Navigating social interactions can be particularly stressful for autistic individuals. Misunderstandings, the pressure to conform to social norms, and difficulties in interpreting social cues can all contribute to anxiety.
- Routine and Predictability: Autistic individuals often prefer routine and predictability. Sudden changes or disruptions to their routine can cause significant stress and anxiety, as they may struggle to adapt to new situations or cope with uncertainty.
- Communication Difficulties: Many autistic people experience challenges with communication, which can lead to frustration and misunderstandings, further exacerbating stress and anxiety levels.
Diagnostic Overshadowing
In PlainSpeak for the Lay Reader
Diagnostic overshadowing happens when doctors or healthcare workers focus so much on a person's autism that they miss other health problems the person might have. This can mean that other illnesses or conditions are not noticed or treated properly.
Key Points:
Mixing Up Symptoms: Sometimes, signs of other health problems are mistaken as just part of autism. For example, if an autistic person feels very anxious or has stomach pain, it might be seen as just them acting up due to autism instead of a separate issue.
Communication Barriers: Many autistic people find it hard to explain their feelings or symptoms and may have other communication challenges. This can make it harder for doctors to understand what's really going on.
Assumptions: Doctors might assume all problems are because of autism and not look for other causes. This can lead to missed diagnoses. Usually any acting up behaviors is redirected back to behavior therapy, when they actually needed different solutions.
Lack of Training: Not all doctors know how to spot other health problems in autistic people. They might need more training to do this well.
Poor Treatment: If other health issues are not found, the person might not get the right treatment. This can affect their immediate and long term health and well-being.
Examples:
Mental Health: If an autistic person is feeling very sad or has depression, it might be ignored because it's thought to be just part of their autism.
Physical Health: If an autistic person has pain in their stomach, it might be seen as just a behavior issue rather than a real medical problem.
How to Fix This:
Thorough Check-Ups: Doctors should look at the whole person and not just their autism. They should check for other health issues and underlying issues too.
Better Training: Doctors should learn more about how to spot other health problems in autistic people.
Clear Communication: Finding better ways for autistic people to share how they feel can help doctors understand their symptoms better.
Awareness: Helping everyone, including caregivers and educators, and professionals understand that autistic people can have other health problems too.
Versions of this post
Disability and Poverty is a tough cycle
In PlainSpeak for Lay Audience
Disability and Poverty: A Tough Cycle
Disability and poverty are closely connected. This makes life harder for disabled people. Here’s why.
Education: Many disabled people don’t get a good education. This makes it hard for them to learn skills needed for good jobs.
Jobs: Disabled people often face problems finding jobs. There aren’t enough job opportunities, and some employers discriminate against them. Without good jobs, it’s hard to earn enough money.
Healthcare: Poor people often can’t afford good healthcare. This can lead to untreated health problems that cause or worsen disabilities.
Support Services: Disabled people need special support, like assistive devices or home modifications, but these can be expensive. Without money, they can’t get the help they need.
The National Council on Disability says that these problems make more disabled people live in poverty. The World Health Organization also says that we need to solve both poverty and disability issues together.
To break this cycle, we need to:
- Provide better education for disabled people.
- Create more job opportunities and stop workplace discrimination.
- Offer better social support services.
- Make healthcare and housing affordable and accessible for everyone.
When we invest in these areas, we help disabled people live better lives. This also helps reduce poverty and builds a stronger, fairer society for everyone.
2 versions of this post
Disability is both a cause and consequence of poverty
"Disability is both a cause and consequence of poverty.
We're more that 2x likely to live in poverty than non-disabled people"
Disability and poverty are intrinsically linked, creating a vicious cycle that exacerbates the challenges faced by the disabled. This disparity stems from systemic barriers in education, employment, and healthcare. Disabled individuals often encounter limited job opportunities, workplace discrimination, and inadequate support services, significantly hindering their ability to secure stable and well-paying employment. According to the National Council on Disability, these employment challenges contribute heavily to the higher poverty rates among disabled individuals (National Council on Disability, 2017). The lack of accessible education further compounds this issue, as it restricts the skill development necessary for competitive employment.
Moreover, poverty can lead to or worsen disability, creating a continuous loop of disadvantage. Individuals living in poverty often have limited access to healthcare, resulting in untreated medical conditions that can lead to further disability. The financial strain associated with poverty can prevent people from obtaining necessary assistive devices or modifications, further diminishing their quality of life and ability to participate fully in society. The World Health Organization (WHO) emphasizes that this cyclical relationship underscores the need for comprehensive policies and programs that address both poverty alleviation and disability inclusion simultaneously (WHO, 2011). Breaking this cycle requires concerted efforts to create inclusive educational and employment opportunities, enhance social support systems, and ensure equitable access to healthcare and other essential services for disabled people. Investing in these areas not only improves the lives of disabled individuals but also fosters a more inclusive and equitable society, reducing overall poverty and promoting economic stability.
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A plain language version
Disability and Poverty: A Tough Cycle
Disability and poverty are closely connected. This makes life harder for disabled people. Here’s why:
Education: Many disabled people don’t get a good education. This makes it hard for them to learn skills needed for good jobs.
Jobs: Disabled people often face problems finding jobs. There aren’t enough job opportunities, and some employers discriminate against them. Without good jobs, it’s hard to earn enough money.
Healthcare: Poor people often can’t afford good healthcare. This can lead to untreated health problems that cause or worsen disabilities.
Support Services: Disabled people need special support, like assistive devices or home modifications, but these can be expensive. Without money, they can’t get the help they need.
The National Council on Disability says that these problems make more disabled people live in poverty. The World Health Organization also says that we need to solve both poverty and disability issues together.
To break this cycle, we need to:
- Provide better education for disabled people.
- Create more job opportunities and stop workplace discrimination.
- Offer better social support services.
- Make healthcare and housing affordable and accessible for everyone.
When we invest in these areas, we help disabled people live better lives. This also helps reduce poverty and builds a stronger, fairer society for everyone.
2 versions of this post
Diagnostic Overshadowing
Autism Lexicon: Diagnostic Overshadowing
Diagnostic overshadowing in autism occurs when the symptoms and behaviors associated with autism obscure or overshadow the presence of other mental or physical health conditions. This can lead to misdiagnosis, underdiagnosis, or delayed diagnosis of other conditions, ultimately impacting the individual's overall care and treatment outcomes.
PlainSpeak: Diagnostic overshadowing in autism is when doctors focus too much on autism and miss other health problems because they think it must be all because of autism.
Read in more detail...
The role of the autistic in research
Thoughts around autistic people leading research rather than only participate by giving accounts of lived experiences.
I think rather than talking about one autistic or neurotypical being the leader, which seems to imply a position of dominance by one group, we should be thinking more in terms of what Judy Heumann used to term as Collaboration Cooperation. Both disabled researchers and non disabled researchers need to work together for meaningful change. And most research is a team effort anyway. What the non disabled researchers bring to the table is a lot of experience in how to go about research and they’ve had a couple of centuries of head start in this. When you combine this with collaboration and leadership of autistic researchers you get the following added benefits.
I think rather than talking about one autistic or neurotypical being the leader, which seems to imply a position of dominance by one group, we should be thinking more in terms of what Judy Heumann used to term as Collaboration Cooperation. Both disabled researchers and non disabled researchers need to work together for meaningful change. And most research is a team effort anyway. What the non disabled researchers bring to the table is a lot of experience in how to go about research and they’ve had a couple of centuries of head start in this. When you combine this with collaboration and leadership of autistic researchers you get the following added benefits.
- Autistic insights through a nuanced understanding of autistic experiences that cannot be fully captured by observation or second-hand accounts.
- Innovative approaches through distinct cognitive and perceptual experiences. This can lead to innovative research methods and findings that might be overlooked by non-autistic researchers.
- Increased relevance and application towards practical and relevant issues.
- Empowerment and representation as autistics in leadership, challenges traditional narratives of them only being research subjects.
- Reducing bias in data interpretation from a neurotypical lens.
- Building trust among autistic participants that this research is likely to be ethical and beneficial.
- Policy and practice impact as autistic researchers are more likely to advocate for changes that directly improve the lives of autistics. Their leadership in research can influence policy, educational practices, and therapeutic approaches in ways that are more aligned with the needs of the autistic community.
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