TBI Regressive Autism

Ameliorating Hemianopia with Multisensory Training (Rowland et al., 2023)

Quick Summary of paper . An  visual-auditory stimulation therapy was used on two older males  who has loss of vision in the left hemifield (hemianopia). The cause was brain trauma (TBI) rather than lesion.  Prior to joining the study both had been referred to PT and OT as rehabilitation measures. 

• 64 year old JM joined the study 14 months after stroke  (2 infracts)
• 74 year old CW joined the study ~18 months after 1 infract (better sighted field compared to JM). 
• Therapy took place over 8 months /10 sessions 

The results were dramatic. Both patients recovered the ability to detect and describe visual stimuli throughout their formerly blind field within a few weeks. They could also localize these stimuli, identify some features, and perceive multiple visuals simultaneously in both fields. (more detail on paper here link)

Relating all this back to Autism

So impressive about being able to restore sight in a matter of 8 months, given therapy was started 14-18 months after infract and not immediately and it was in older adults. 

Why is regressive autism not thought to be TBI at 18 mo, where there is a sudden loss of learned skills. 

• If TBI --> can those lost skills not be regained through targeted therapy. If you can restore skills in 60-70 yr old, should be able to, in a younger more plastic brain. 
• If TBI -->  is this related to CW & JM having practice with vision for 60-70+ years vs toddlers who only have practice with the skills for 18 mo.

Rethink Traditional Therapies

• CW & JM  had PT/OT for 14-18 mo before joining study; implication these therapies not that useful for regaining lost skills. 
• Autistics kids are in insane amounts of therapy (childhood stuffed with ABA/speech/OT every waking hr with little advances to show for it other than the $$$ spent and lots of career advancement for therapists). 
•  Maybe we need rethink early childhood therapy to be more targeted to restore lost skills. Even regaining that level of lost skills improves quality of life, let alone moving beyond.

One big vagary

Vagaries ubiquitous in autism.
Nothing standard, fractured light in a prism.
Can we conclude then, so far…..
… no evidence in any evidence really
….no clues. What’s going on in this gallery.
inexplicable me. I continue to be one big vagary.

Cellular neuroscience is tough.

Cellular neuroscience  is tough. 

=====

I'm like a library book, overdue
My brain's so full, it's about to bust in two
I feel like I'm stuck in a never-ending test
Studying so much, I'm starting to feel depressed!
Will it bring success to my quest?



This was the response from my friend in my neuroscience cohort. Thank you for the encouragement and empathy. 

Will it bring success to my quest?
Simply stated, my answer is yes

Battling through the constant stress, through days, months, years of duress
Though now life may seem like a mess, the quest is not to be the best,
Prioritize self-care, remember to rest

Is it worth it, when all I see, are cloudy skies up over me?
Yes I say, the world will see, what's possible with a degree,
The journey to a PhD is sprinkled serendipity,
But even more importantly, be free to show YOU empathy!

Hari,
Above all you are my friend, one that will be there 'til the end,
Remember I am here for you, day in, day out, through and through.

WAIS - Wechsler Adult Intelligence Scale

Lexicon [Measures] - WAIS 

The Wechsler Adult Intelligence Scale (WAIS-IV) is an IQ test used in adults (ages 16-90) to assess cognitive abilities across different domains. It can take around 60-90 minutes to complete

Limitations in the context of autism:

• Language and communication challenges can impact performance on subtests that heavily rely on language abilities.
• Sensory sensitivities and attentional difficulties affect their performance on tasks requiring sustained attention or visual processing.
• Social and contextual factors/aspects of intelligence relevant to autism not considered as the test focuses on cognitive abilities.
• [Also see post on why IQ tests problematic in autistics] 

WAIS-IV has 10 core subtests which are organized into four index scores.

1. Verbal Comprehension Index (VCI):
• Similarities: verbal reasoning and concept formation.
• Vocabulary: ability to define words and understand their meaning.
2. Perceptual Reasoning Index (PRI):
• Block Design: visual-motor coordination and spatial perception.
• Matrix Reasoning: non-verbal reasoning and problem-solving skills.
• Visual Puzzles: ability to analyze and synthesize visual information.
• Picture Completion: visual perception and attention to detail. Presented with incomplete pictures and are required to identify the missing part or detail.
3. Working Memory Index (WMI):
• Digit Span: attention, concentration, and working memory by assessing the ability to repeat a series of digits forward and backward.
• Arithmetic: mental arithmetic skills and working memory.
4. Processing Speed Index (PSI):
• Symbol Search: visual scanning speed and processing speed.
• Coding:motor speed, attention, and visual-motor coordination.

Scoring and interpretation

Index scores are derived from specific combinations of subtests and provide an overall assessment of an individual's cognitive strengths and weaknesses in those domains.

The Full-Scale IQ (FSIQ) is the combination of the index scores. It represents overall intellectual functioning and is calculated based on the combined performance across all subtests.

Interpretation involves comparing an individual's performance to normative data (percentile ranks, confidence intervals, and descriptive categories), considering the person's age and the index and subtest scores obtained. 

History
WAIS was first developed by David Wechsler as an adaptation of his earlier intelligence tests, the Wechsler-Bellevue Intelligence Scale (1st Ed 1955, 4th Ed 2008).