McGlade et al 2023: Effectiveness of Early Intervention Therapies
My take: If early childhood therapy was so "effective", then the thousands of kids who have had massive amounts of therapy all through childhood (starting with early intervention) would have "RECOVERED" may times over. Why are my challenges still significant - ie: all that therapy did not make a dent. Currently there is no such thing as gold-standard childhood therapy. Most autism therapy is hit-or-miss, at any age. Its just $$$$ spent on trial and error. Lots of careers and promotions.
Recently there was a twitter post pointing out that since were were no readily available "statistics" (referring to it as a "cool autism fact") showing numbers of the more significantly impacted adult autistics meant that numbers of this group must be overstated. Others in the thread questioned if adult autistics who did not not speak, even existed, since that autistic posting had learned to speak at age 3. This an irresponsible statement and an erasure of the huge number of non-speaking or minimal verbal adults who need to be part of the autism solutions.
Onto the paper.
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- Limited evidence to recommend very early interventions for infants and toddlers with autism.
- Limited impact of early intervention for at-risk infants/toddlers (by age 3.
- No significant treatment effects for autism symptoms, cognitive outcomes, receptive/expressive language. Even neurocognitive outcomes (EEG and eye tracking) were inconsistent.
- Gold-standard early intervention is yet to be developed. Future treatment will need to include novel and individualized intervention targets alongside the targeting of parental responsiveness.
Questions that arise.
- What are the implications of these findings for clinical practice and policy related to early intervention for autism?
- What are the long-term outcomes of very early interventions for infants and toddlers with autism beyond age 3 years?
- What are the ethical considerations related to intervening in infants and toddlers at increased likelihood of autism dx, and how can these be addressed in future research and practice?
Disabled People are not ADA People.
People with disabilities are not “Americans with Disabilities Act people” or “Americans with Disabilities Act Guests.” The ADA is a law that increases equity for disabled people, not a label of any individuals. Referring to people with disabilities in this way is disrespectful and never appropriate.
Navigating the intersection of AuDHD (Autism and ADHD)
I've had the combined diagnosis of Autism and ADHD (AuDHD) since age 3. What does having a combination diagnosis look like? [A Plain Language version at the end of post]
Autism and ADHD often co-occur, a combination referred to as AuDHD by many self-advocates. Together, they form a unique blend of traits that can sometimes be contradictory, affecting various areas of life, from relationships and academic performance to sensory processing and emotional well-being. Understanding AuDHD involves recognizing how the need for routine and predictability (autism) intersects with a craving for novelty and spontaneity (ADHD).
Contradictory Traits: Sameness vs. Novelty
One of the key challenges of AuDHD is the internal conflict between autism’s preference for routine and ADHD’s need for newness. Autistic individuals often thrive in predictable environments that reduce anxiety and create a sense of control. In contrast, ADHD pushes for novelty, leading to restlessness or boredom with repetitive tasks.
For someone with AuDHD (or AutDer), this contradiction can cause significant internal tension. The autistic side may seek consistency, while the ADHD side yearns for new experiences. This constant push and pull can result in stress and frustration, as they struggle to balance these opposing needs.
Sensory Processing: Overwhelm and Seeking Input
Sensory challenges are common in both autism and ADHD, and in AuDHD, these can intensify. Autistics may experience hypersensitivity to stimuli—lights may feel too bright, sounds too loud, or textures uncomfortable—leading to sensory overload. ADHD, on the other hand, may result in increased distractibility and a heightened need for sensory input, such as fidgeting or movement.
This combination means that individuals with AuDHD (or AutDers) may frequently feel overwhelmed by their environment or seek out additional sensory stimulation to stay focused. For example, stimming (repetitive behaviors like tapping or rocking) may become more frequent or intense as a means to self-regulate. [More detail on this at this link]
Cognitive Styles: Hyperfocus vs. Distractibility
AuDHD significantly impacts cognitive styles, with autistic individuals often demonstrating hyperfocus—intense concentration on a particular interest for extended periods. This can be a strength when aligned with personal or professional goals, but it may make switching tasks difficult.
ADHD, by contrast, brings distractibility, where maintaining focus on tasks that aren’t immediately engaging becomes challenging. AutDers might experience cycles of hyperfocus followed by difficulty completing less stimulating tasks, leading to issues with time management and task completion.
Social Identity and Stigma
AutDers often face challenges related to identity and belonging. The dual diagnosis may make it difficult to fit neatly into autism or ADHD communities, leading to feelings of isolation. Additionally, misunderstanding of how AuDHD manifests can contribute to societal stigma, with people often being misperceived as lazy, disorganized, or socially awkward. This lack of awareness can result in inadequate accommodations in school, work, and social settings.
Relationships and Family Dynamics
Maintaining personal relationships can be a significant challenge for those with AuDHD. Autism can bring difficulties in reading social cues and understanding nonverbal communication, while ADHD may add impulsivity and distractibility to interactions. Together, these traits can cause misunderstandings or strain in romantic relationships, friendships, or family dynamics.
Academic and Workplace Performance
In academic settings, the need for structure (autism) and the tendency to procrastinate or get distracted (ADHD) may clash, making it hard for AutDers to meet deadlines or engage in group work. Similarly, in the workplace, inflexible environments that don’t account for the needs of those with AuDHD may result in job dissatisfaction or burnout. However, with appropriate accommodations, such as flexible schedules and task-focused roles, AutDers often excel in creative problem-solving and innovation.
Emotional Sensitivity and Interpersonal Conflict
Both autism and ADHD are associated with emotional sensitivity, and AuDHD can heighten this trait. Individuals may become overwhelmed by criticism or social rejection, overthink social interactions, or feel emotionally exhausted by perceived failures or misunderstandings. The combination of difficulty in social understanding (autism) and impulsivity (ADHD) may also lead to frequent interpersonal conflict.
Executive Functioning: Organization and Planning Struggles
AutDers often experience challenges in organizing, planning, and managing time due to the combination of autism’s need for structure and ADHD’s impulsivity. Individuals may feel overwhelmed by the need to create detailed plans but struggle to implement them effectively. This can lead to feelings of frustration, especially when routine gets disrupted.
Emotional Regulation and Mental Health
Both autism and ADHD are linked to emotional dysregulation, and their combination in AuDHD can intensify this. The internal conflict between the need for routine (autism) and the craving for novelty (ADHD) often leads to anxiety. ADHD’s impulsivity can contribute to emotional outbursts, which can result in guilt or heightened social anxiety later. Over time, the struggle to navigate these conflicting traits may lead to emotional exhaustion or burnout.
Self-Esteem and Identity
AuDHD can also impact self-esteem. Individuals may struggle with societal expectations that conflict with their neurodivergent traits, leading to feelings of inadequacy. The clash between needing structure (autism) and having difficulty with focus or organization (ADHD) can leave people feeling as though they are falling short, especially in school or work environments where both conditions are often misunderstood.
Physical Health: Sleep and Motor Coordination
Both autism and ADHD are linked to sleep disturbances. Autism can make it hard to fall asleep due to sensory sensitivities or the need for specific routines, while ADHD may result in restlessness. Combined, AuDHD can make restful sleep difficult, leading to daytime fatigue and irritability.
Motor coordination may also be impacted, as both conditions are associated with clumsiness or dyspraxia (developmental coordination disorder). This can affect confidence in activities like sports or even daily tasks like driving.
The Bigger Picture: Neurology and Physiology in AuDHD
Neurologically, AuDHD affects several areas of the brain, particularly the prefrontal cortex, which manages executive function, planning, and decision-making. ADHD often involves dysregulation in dopamine pathways, affecting reward processing and motivation, while autism involves differences in connectivity between brain regions, particularly in areas related to social cognition and sensory processing.
These neurological differences can result in heightened sensory sensitivity, fluctuations in attention, and difficulty managing emotions. The combination of these traits can also make it harder to filter out distractions or regulate behavior, leading to emotional stress or frustration.
Sensory-Motor Coordination and Physical Health
Both autism and ADHD can lead to motor coordination challenges, but when combined in AuDHD, these issues may be even more pronounced. Individuals may struggle with fine motor tasks like handwriting or sports, impacting confidence in physical activities. Additionally, balancing routines with ADHD's impulsivity can affect physical health routines like exercise, meal planning, and sleep.
In Essence…
AuDHD is more than just a combination of autism and ADHD traits. It creates a unique set of challenges that require personalized strategies to thrive. While the need for routine may clash with the desire for novelty, understanding these complexities opens the door to both challenges and strengths. Tailored support is essential for individuals with AuDHD to find balance and success in daily life.
By addressing sensory sensitivities, understanding cognitive differences, and providing appropriate accommodations, individuals with AuDHD can harness their unique strengths while managing their complex needs
PlainSpeak: A plain language version for the lay reader.
Navigating Life with AuDHD
Autism and ADHD are two conditions that often occur together, known by many as AuDHD. While both have unique traits, they can sometimes seem at odds with each other. Autism often comes with a need for routine and predictability, while ADHD tends to seek novelty and excitement. This mix can create challenges in many areas of life, from social interactions to managing sensory input, attention, and emotions.
Conflicting Needs: Routine vs. Newness
People with autism often find comfort in routines and predictability, which help reduce anxiety and manage sensory overload. ADHD, on the other hand, thrives on new experiences and gets bored with repetition. This combination can make daily life feel like a tug-of-war between craving stability and wanting change.
Sensory Overload vs. Sensory Seeking
Both autism and ADHD can impact how a person handles sensory input. Autistic individuals may be sensitive to bright lights, loud sounds, or certain textures, making them prone to sensory overload. ADHD can add another layer, making it harder to filter out distractions or even leading to seeking out sensory experiences (like fidgeting). Together, these traits can make it tough to find a comfortable sensory balance.
Focus: Hyperfocus vs. Distraction
Autistic individuals can sometimes hyperfocus, becoming deeply absorbed in something they’re passionate about for long periods. ADHD brings in distractibility, making it harder to stay on task, especially when something isn't interesting. With both, a person may swing between being super focused on some things but easily distracted by others, making time management challenging.
Social Struggles
Social interactions can be tough for AutDers (people with AuDHD). Autism may bring difficulties with understanding social cues or communication norms, while ADHD might lead to impulsive actions like interrupting conversations. This combination can cause misunderstandings and social fatigue, where engaging with others becomes exhausting.
Organization and Planning
Both autism and ADHD can make it hard to plan, organize, and manage time. Autism often brings a need for structure, but ADHD's impulsivity might disrupt that structure, leading to procrastination or forgetfulness. This creates frustration, especially when trying to stick to a routine or meet deadlines.
Emotional Challenges and Mental Health
The emotional toll of managing both autism and ADHD can be significant. Both conditions are linked to anxiety and depression, and having both can make emotional regulation even harder. The conflict between needing routine and seeking novelty can cause internal stress, leading to emotional exhaustion or burnout.
Impact on Self-Esteem
Having AuDHD can affect self-esteem, especially when people don’t meet societal expectations. The need for structure in autism might clash with ADHD's distractibility, leading to feelings of inadequacy, particularly in school or work environments that don’t understand their challenges.
Physical Health: Sleep and Movement
Sleep can be tough for those with AuDHD. Autism may cause sleep difficulties due to sensory sensitivities, while ADHD may lead to restlessness. This combination can result in sleep disturbances, leading to daytime fatigue. Motor coordination may also be affected, making physical activities like sports harder to engage in confidently.
The Bigger Picture
AuDHD is more than just a blend of autism and ADHD traits. The combination creates unique challenges, but also opportunities for growth and strengths. With the right strategies and support, AutDers can learn to manage their needs and thrive in ways that work for them.
Chipper Ahoy
View from my bedroom window this morning
A woodpecker chipping away at a tree stump.
The red tuft on his head bobbing up and down.
Wood chips and sawdust scattered around.
Perchance, a nest or insect snacks in stump cracks?
Chipper Ahoy!!
A neat oval hole in the tree stump.
6' (depth) x 6" (long) x 4.5" (wide)
Chipper mate!
What further plans have you in mind?
With flibbertigibbet in his chops
feathers shimmer, beak goes knock-knock
feathers shimmer, beak goes knock-knock
As he dances on a tick-tocking clock
Cool mornings, mild afternoons to start the week
That's the weather forecast for today!!
Cool mornings, mild afternoons to start the week
Cool mornings, mild afternoons to start the week
Nashville April in action, so to speak.
One day it's sunny, the next it pours,
But hey, at least don't need jackets outdoors!
Easter Egg Hunt.
Had a great time at the Easter Egg Hunt organized by lab-mate Kimmy. Lots of student turn-out at Fannie Mae Park. The kids taking part sure had fun collecting eggs.
This is 2023. Why are shocks still part of Autistic Behavior Therapy?
This is 2023: Shocks are being used on autistics as part of ABA Therapy. The UN calls it "torture". Read this article by Eric Garcia in the Boston Globe.
1965: The images show a Photo Essay that appeared in the 1965 issue of Life Magazine about ABA therapy being done on Autistic Kids with Dr Loovas. Shocks were used as aversives - the floor is laced with metal strips and the autistic girl in the picture is barefooted.
Moser, D., & Grant, A. (1965). Screams, slaps & love: A surprising, shocking treatment helps far-gone mental cripples. Life Magazine, 90-102
A link to the full article is at https://cpb-us-e1.wpmucdn.com/blogs.uoregon.edu/dist/d/16656/files/2018/11/Screams-Slaps-and-Love-Life-Magazine-13javg3.pdf
One small act of kindness can make a big difference is someone's life
Towards a more Humane Society. Contemplating a different emotion and writing one line each day on it. #MentalHealth. This month on KINDNESS
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