Hello and Goodbye

I am happy to say this is Interverbal’s (the blog’s) 6^th birthday. I am sad to say this will be the last post on Interverbal. When I created Interverbal, I was an undergraduate just about to head out to grad school. I did most of my best work on this blog during my first year or so as a grad student. I was younger, feistier, and very much believed in doing science advocacy in an aggressive manner. I spent most of my time working on anti-quackery as it pertained to autism.

I have found that over time, my attitude has gentled. I became more patient with mistakes and disagreements. My interest in constantly debunking anti-quackery also waned.  It is clearly time to try something different. I am placing Interverbal into retirement, but will leave it up as a resource, as I feel there is some good work here.

On the other hand I am pleased to announce my new blog. Which will focus on teaching children with autism.

Reviewing Green et al. (2010)

Green et al. (2010) used random assignment to assess a parent based intervention for children diagnosed with autism. The study is being discussed as a marked improvement over current research in the autism field. I disagree.

With this study you get:

-Random assignment

-sample (n) >30

And that is it for advantages. I honestly think people see the words "random assignment" and a big (n) size and put this study on a pedestal. It doesn’t deserve it, even compared to what is currently available.

In group design there are the following threats to internal validity:

-History (controlled in this study)
-Experimental mortality (controlled in this study)
-Regression toward the mean (controlled in this study)
-Maturation (a problem in this study)
-Instrumentation (a problem in this study)
-Testing Bias (a problem in this study)
-Instrumentation (a problem in this study)
-Selection Bias (controlled)

I don’t see how the authors can claim fidelity of the intervention. The parents were applying the intervention (or not) as the case might be. Occasional direct measures a la the videotapes or clinical visits are no guarantees of fidelity. This is a not a minor problem when doing consultation. It is a huge problem. Also, non-blinded terminal testing such as the ADOS is a concern. Where are the direct behavioral measures?

This is not a true experimental design; this is an indirect study that uses random assignment. The use of random assignment may be an anomaly, but it is not a step forward in this case.

Notes: For a different view of this research go see Michelle's analysis.

That Annoying Voice

That voice….you know the one…. Over-calm and too slow. It probably drove you crazy when you heard it at a certain point in your life. If I were to just say “the voice” in relation to education, I bet most of you would know what I am talking about. We were warned about “the voice” in teacher preparation. I have read articles by self-advocates who are not too fond of “the voice”. I typically was unimpressed early in my training whenever I heard someone using “the therapy voice”.

It was with great shame that I recently caught myself using “the voice”. I cried myself to sleep that night. Well okay, I wasn’t nearly that bothered by it. But I was a little bothered by it. Why was I unknowingly using the voice? I began to pay attention and analyze my own behavior. I noticed 3 things were true when it occurred.

1) It occurred when I taught a large group lesson, but not during 1:1 or small group lessons
2) It occurred when some of my students were getting rowdy during the lesson.
3) It occurred when I was personally feeling un-calm.

My large groups tend to be with very young students (ages 5-7). They get rowdy very easily. They are very reactive as a group to my actions and energy level. By talking in a deliberate calm voice maybe I was trying to keep the group’s energy directed. Also, it can be frustrating to try to keep the attention of 10 young persons. Everyone is responding and on task but Susie. I work to gain Susie’s attention, but then Rob and James decide to have a friendly pinching contest. Maybe I am also trying to keep myself calm and on par as I gently redirect Bob and James to find seats that are not next to each other.

There is also the fact that some of my students take longer than average to process directions. By slowing things down and sometimes pausing, I increase the chances of my students successfully following my directions.

“I need everyone to STAND UP……PUSH IN your chair….and line up at the door.”

Combine an overly calm tone with a speech rate that has been slowed down and I think you may end up with something like “the voice”. It is very true that my behavior was shaped by my students. I was reinforced by the gratifying sight of on-task, cooperating students based on how I used my voice. And while older children would have rolled their eyes at me or told me they didn’t like how I was speaking. Younger children are not older children. The avidity with which the Kindergarten set will watch (gag me with a spoon) Blue’s Clues is proof of this.

Now, even though the reason I used the voice had nothing to do with condescension , there are other good reasons not to use it. Such as the fact that it tends to annoy anyone older than 8. So, I began to look for other ways to help lead my big groups using my voice. I make use of some of the following strategies:

1) Whisper instruction very softly
2) Translate spoken drill and practice into a song
3) Deliberately speak or sing very, very fast
3) Deliberately speak or sing very, very slow

None of these are foolproof or always effective. And while they can be used to maintain student’s attention pro-actively, they are not sustainable beyond a few sentences worth of information. You will have to be judicious in their usage. I truly hope someone finds these experiences helpful.

Why Can’t We All Just Get Along

This is a continuation of a previous discussion between MJ and myself in my last post. This issue has cropped up previously and I realized I wanted to prioritize the discussion and make it a little more accessible to others. My apologies to MJ for the change in format.

“That first part is as important as the second because until the community stops tearing itself apart it will be hard to move forward.”

Let’s say the Autism Hub and the AoA merged tonight and became “The Age of the Hub” or something like that. Do you really expect that the AoA editors will lay off vaccines? Reciprocity is a two way street.

When I truly think about it, I don’t agree that laying off legitimate criticism is ethically justified. Let’s say Muchoverbal (fictitious) and Interverbal are having a fight, about whether a new autism treatment study is dangerous. Should they abandon their fight so that they can both better advocate on a shared issue. Training police to effectively differentiate being high from being autistic, perhaps? It produces a good, but I am not sure it is ethically justified.

But wait, couldn’t Muchoverbal and Interverbal still work together on the police matter? Unlike the treatment study, the gaps are not ideological. They could work together on the police matter and agree to disagree on the study. Really, the gaps are only emotional.

So….. why haven’t they already? Maybe there are other gaps here as well?

Geraldine Dawson Disappoints

In a New York Times, letter to the editor Dawson writes:

The latest British Medical Journal paper about autism and vaccines, which provides evidence that the initial report linking autism and vaccines was fraudulent, and the media coverage that ensued, miss an important point: Until science discovers the causes of autism and explains its dramatic increase, parents will continue to reach their own conclusions and desperately try a wide range of treatments, whether there is evidence to support them or not.

The answer is not to look to the past and look for blame, but rather to look to the future. We need increased research financing directed toward rigorous science that can provide the answers that parents are looking for and deserve. Until this happens, we will continue to wallow in controversy, and people with autism and families will continue to struggle with autism on their own.

Geraldine Dawson
Chief Science Officer, Autism Speaks
New York, Jan. 13, 2011

I do not agree with Dawson about “missing the point”. The BMJ article deals in part with the foundations of the vaccine etiology of autism movement, not its continuing trajectory. To advocate that an author call for more research in an article devoted to indentifying fraud feels like a patent absurdity. Frankly, it feels agenda based.

Also, I do not think better research would resolve the issue. I think even if damningly conclusive research were to come out tomorrow on all the issues Dawson raises, the hard-core of vaccine etiology advocates would roll on with lots of accusations of giant conspiracies. And I think a lot of the soft-core people would drink the cool-aide and stay with them.

Dawson talks about missing the point. I think this is ironic, because the obvious point Dawson misses is the vaccine etiology of autism movement may roll along in spite of all the science in the world.

Finally, I do not appreciate the way Dawson says “The answer is not to look to the past and look for blame”. Wakefield committed fraud, a very deliberate act where he knowingly misled others. And this led to harm. To advocate that we ignore this misconduct so as to better focus on upcoming research is contrary not just to ethical standards, but to scientific standards as well. Frankly, this is outrageous. I do not see scientific integrity as a priority for Dawson, and given her current position this disturbs me.

Abuse

Please read the post and watch the video at Ed's blog. It indentifies a case of school based physical abuse and what appears to be the effort to suppress/punish the whistle blower.

I do think there is systemic enablement of this sort of thing. How do address this problem would be a very worthwhile post all by itself.

Silly Speculations

A lot of fun is being had at the expense of a certain editor of the Age of Autism. Frankly, it seems richly deserved. Read his claims here.