Monthly Archives: February 2012

Psychoanalytic Woo for Autism

However we may judge the legacy of Sigmund Freud’s ideas, when it comes to understanding autism these ideas have been detrimental. The most recent example to make the news, The International PreAutism Network [iPan] may seem benign in comparison to Refrigerator Parents or Le Packing. But the effect is no less insidious for all that. Melanie Sykes is a TV presenter with an autistic son who donated her winnings from a celebrity game show to iPan.  I first came across iPan at a conference on autism. Their material had been inserted in the conference goody bag for delegates. Fortunately, as an invited speaker, I was able to denounce their psychobabble in an impromptu addition to my presentation. I have subsequently been invited back. iPan’s material is no longer included in information packs for delegates. I thought no more about them until I came across a recent entry in the Quackometer that referred to the Melanie Sykes story.

Autism, as we have come to understand it, was an unknown concept in Freud’s day and age. According to Grinker, in Unstrange Minds, (page 44)

Before Kanner, “autistic” referred to a symptom not a syndrome. Sigmund Freud talked about the word “autistic,” too. He contrasted the “social” with what he called the “narcissistic,” but was quick to point out that by “narcissistic” he meant the same thing as “autistic,” “in which the satisfaction of the instincts is partially or totally withdrawn from the influence of other people.” Freud didn’t like the word “autistic” at all, but it’s not clear why. He may have objected to the fact that by the early 1920s some physicians had started to use the word “autistic” to refer to daydreams and fantasies; Freud thought the word, if it was used at all, should refer to an impairment in social functioning. It’s amazing that Freud was so perceptive, so long ago.

Unfortunately for us, since Freud’s death his followers have been less perceptive in divining the cause of this social impairment. iPan is more subtle than the hapless Tony Humphreys, currently courting controversy (and publicity for his self help manuals) after a provocative article in the Irish Examiner.

iPan try and have it both ways. They are careful not to blame parents. But they do maintain that there is a break down in the normal infant – caregiver relationship. They suggest that the breakdown originates in the child but the parental response is crucial. If you spot the warning signs early enough and learn how to deal with them the incipient autism can be prevented.  They claim these warning signs of autism are detectable as early as three months old. Intensive psychodynamic therapy for the infant  and the family - 6 hours per day, 6 days a week for three to four weeks and hour long weekly sessions afterwards for an unspecified time period – are supposed to prevent the autism developing. They have a clever advertizing slogan:

It can be too late but it can never be too early

So, if you have any worries at all contact iPan before it is too late. They have a helpful checklist of behaviours to look out for.

Social Interaction
Is the baby unresponsive to your voice or to their own name?
Does your baby not smile at you when they see you?
Does he or she not make eye contact ?
Does he/she “pull back” when you lift them up?
Does your baby prefer to play alone or with objects versus play with other children?

Communication
Do you notice that your baby does not “babble”, or make typical baby noises? or
Does he/she repeat sounds over and over?
Does your baby seem excessively irritable / fussy?
Behavior
Does your baby sleep excessively for their age?
Does your baby seem too subdued?
Does your baby seem too stiff or too floppy?
Is the baby obsessed with certain objects?
Does your baby appear to become overwhelmed by certain sounds and noises?
Does your baby not want to be laid on their stomachs?

Parent
Does your child “worry you”?
If so, trust your intuition! Call us and inquire about what you can do to treat the early signs of autism or review our section on What Can You Do?

I imagine that most parents reading that list will find something to worry about. So they download the checklist of 17 items for the child and 11 for the mother or caregiver. It is the sort of checklist that an undergraduate might devise as part of their course work but would be unacceptable in anyone studying for a higher degree. It is an observation schedule that confusingly also invites the observer to make judgements about intentionality and capacity. Each item can be scored as never, twice or less, more than twice, always over an hour of observation. So how do you score this?

ABILITY TO RELATE
–To other children
–To adults

Or

EXPRESSIVENESS
–The body or facial expression of emotional states (e.g. sad, worried, anxious, bland, happy, or others) specify

Somebody without any training, presumably a relative, is supposed to complete this while observing parent-child interactions for an hour. You send back the completed checklist along with a home video of the behaviour that you are worried about and iPan will diagnose whether or not your child has pre-autism and book you in for therapy.

iPan does not deliver the assessment or the therapy. That is down to its partner charity, the Parent Infant Clinic. Their website is a mixture of accepted knowledge about normal child development and unsubstantiated speculation about how this is affected in autistic children. So they compare brain scans of normal children with traumatized Romanian orphans to show the impact of bad caregiving on children and follow up with a simplistic account of redundancy in the developing brain and suggest that emotional factors are decisive in determining which neural networks are strengthened and retained.

Research confirms our work.
When we first began our work with infants and parents three decades ago, we were working from clinical intuition. Today, neurobiological research validates our early findings that healthy bonds and healthy brains depend on quality relationships with the primary caregivers (usually parents) and on the consequent connections of neurons in the brain.

It is all a bit too glib. There are none of the nuances, qualifications and acknowledgments of uncertainty that I get from reading the work of neurologists doing the actual research. But there we have it. According to Doctor Stella Acquarone (not a medical doctor but a PhD in psychology), the guiding light behind iPan and the Parent Infant Clinic, psychodynamic theory has been proven correct by neuroscience. So you can sign those cheques for treatment with complete confidence.

There is no mention of cost on the website. We know it is expensive because one of the reasons that iPan exists is to raise money to pay for people to access the treatment. But in 2006 the Daily Telegraph carried a report on this therapy that claimed a cost of just under £30,000.

The treatment, however, does not come cheaply. An initial consultation, depending on whether one sees a senior or junior therapist, can cost up to £100. A three-week intensive course, which involves six hours of counselling each day for six days a week carried out by six senior therapists, costs £29,000.

The Telegraph concluded with some highly critical remarks about the therapy.

Not all child experts are impressed, however. Professor Frank Furedi, a sociologist from the University of Kent in England and author of Paranoid Parenting is scathing. He believes such therapy preys upon parents’ natural anxieties. “At the moment there is an obsession with setting children on the right emotional path from the beginning, from birth,” he says. “Even in day-care centres, the emotional intelligence of children is seen as paramount.
“Increasingly, adults are socialising their children less and less: they are scared to let them play with toys that are not seen as having a developmental outcome. We are even doing this when a child is in the womb, playing them classical music and the like.
“This sort of thing is parasitical. By preying on anxious mothers and re-enforcing those fears, we have created an obsession that if one doesn’t do these things, one is a bad parent.
“Parents would be better off using their intuition. Think about how they behave in the home. About what kind of signals they send out to their children. Getting their children to have a robust sense of what is right and what is wrong early on is much more valuable.”

I do not agree with everything Frank Furedi has to say. But on this occasion he is right to signal alarm.

I am equally concerned by the misunderstanding of autism evident on the Parent Infant Clinic website. If you claim to be able to spot “pre-autism” in babies you should at least be able to demonstrate a basic knowledge of the autistic spectrum. Instead we get this.

In the world of autism there is a wide spectrum of symptoms. Terms can be confusing as there are overlapping symptoms with other disorders. Autism, consequently, is often confused with Asbergers(sic) and other communication Disorders which encompass speech and language irregularities.

Autism is an early psychosis and typically shows up at an early age. Early psychosis means that the child’s mental development process is such that it is hard for them to cope with reality. Signs of autism can be seen from as early as 3 months.

In contrast, Aspergers is a personality disorder and the onset of these symptoms is usually around age 5. The common disorder for Autistic children is typically in the area of poor socialization; while those with Aspergers tend to be much more vocal.

Typically, autistic babies manifest symptoms at a very early age. Autism impacts all aspects of development: emotional, neurological, verbal, and motor. The reason why it is important, even critical, to distinguish early autism and early communication disorders is because the best outcomes come from early intervention with autistic children. It is not that babies with autism can not communicate, rather they do not have the motivation to make sounds or interact with people.

So much inaccuracy in so short a statement. The American Psychiatric Association are about to publish the latest iteration of their diagnostic manual, DSM 5. Are they really so wrong that they have confused a psychosis (autism) and a personality disorder (Aspergers) in one diagnosis - autistic spectrum disorder and called it a neurodevelopmental disorder. Well done iPan for putting me on the same side as the APA.

We began with a news story about a TV presenter and an autism charity. No doubt iPan are well pleased with the publicity arising from Melanie Sykes, a TV presenter who won a charity game show, donating her £50,000 winnings to them. That should cover the treatment costs of at least one child. Melanie is a patron of the charity. She is obviously impressed with the work that they do. Her own son has been through the treatment protocol. It was so effective that in the Daily Mail, Melanie Sykes has said

I have known for five years that he has autism.
‘But I felt it is his business. The thing is he is seven and is about to be officially diagnosed with it.

So, after spending £29,000 on therapy he is about to get his autism diagnosis and his mum recommends iPan to the world. If there was an award for autism quackery Stella Acquarone would be my choice.

The Myth of Autism Part 3

Timimi et al continue to attract attention with their book, The Myth of Autism. Others have been kinder than I was in my previous post. Take this offering from The Psychologist

An alternative voice

The Myth of Autism
Sami Timimi, Neil Gardner & Brian McCabe

Just looking at the brief biographies of the authors of this book, I could not help but be intrigued, and a little bit excited. Written by a child psychiatrist and two adults who have received a diagnosis of autistic spectrum disorder, the book is an exploration of the conditions that have constructed a spectrum, one that they claim is ill-defined and unsupported by evidence. The authors waste no time in making their beliefs very clear within the preface of the book with the bold statement that ‘there is no such thing as autism and the label should be abolished’. This is a brave statement indeed, given the inevitable emotions attached
to such a subject. What follows however, is an in-depth analysis of the scientific, social and political conditions that contribute to the construction of the concept of autism.

The book sometimes loses balance, but you cannot help but be moved to intrigue throughout. As an example, a discussion of dominant social structures that value service industry, and thus social communication skills, implied that there is nowhere for people who are ‘different’ in this respect, to hide. Fundamentally, this book caught my imagination. There were many facets of the book that I have no doubt will feel challenging to a variety of readers, but there were parts that also put words to my own concerns as a practitioner. Writing on autism tends to be heavily weighted towards the contrary view, and as the literature around the apparent genetic contribution to autism continues to gather momentum, it is refreshing and I feel, necessary, to hear an alternative voice among the clamour.

Never mind that the book is plain wrong in many important respects, it is “an alternative voice” and so, rather than subject its claims to the same rigorous analysis that it purports to bring to the concept of autism, we are supposed to welcome it.

Someone else has been reading “The Myth of Autism.” My thanks to the blogger at Three Mile Limit for pointing me to Tony Humphrey’s article in the Irish Examiner on February 3rd. According to his website Tony Humphreys is “Ireland’s most influential psychologist.” To judge by his article on autism this does not bode well for psychology or Ireland. In a nutshell he attempts to resurrect the refrigerator parent thesis that was thoroughly debunked in the 1960s but still holds sway in countries like France, and now it seems, in Ireland, where adherents of psycho-dynamic theories of human development have refused to give way to more evidence based theories based on neurology.

Humphreys begins by taking issue with Professor Simon Baron-Cohen and his team at Cambridge University who are researching whether or not autism is more common amongst the children of parents in professions like computer science and engineering.

In studies in 1997 and 2001 it was found that the children and grandchildren of engineers were more likely to be autistic and that mathematicians had higher rates of autism than other professions. What is shocking is that Dr Baron-Cohen and the team of researchers are one: assuming that autism is a scientific fact and, two: missing the glaringly obvious fact that if the adults they researched live predominently in their heads and possess few or no heart qualities, their children will need to find some way of defending themselves against the absence of expressed love and affection and emotional receptivity.

So autism is not a scientific fact and people who work in the realm of ideas are emotionally defective. This twaddle has been roundly criticized by Three Mile Limit mentioned above, The Family Voyage, Maman Poulet and Bock the Robber. It is also criticized by The Thinking Person’s Guide to Autism and Irish Autism Action on their FaceBook pages.

Then he brings in Timimi et al to support his argument.

Sami Timimi, a consultant child and adolescent psychiatrist and two colleagues rigorously examined over 5000 research articles on autism and ASD and found no scientific basis for what they now refer to as mythical disorders. They outline their findings in their book ‘The Myth of Autism’ (2011). The conclusion of their indepth studies is that “there is no such thing as autism and the label should be abolished”.

The authors are not saying that the children are not emotionally and socially troubled. What they are saying is – and I concur with them – that focus needs to be on the relationship contexts of these children’s lives, and to take each child for the individual he or she is and to examine closely the family and community narratives and discover creative possibilities for change and for more dynamic and hopeful stories to emerge for both the children and their carers.

I do not know how much of “The Myth of Autism” Tony Humphreys has read. Or how well he has read it. The authors never claim to have rigorously examined 5000 research papers. They do refer to the fact one of the authors had a database of over 5000 articles that he had reviewed while working on a thesis on autism. That thesis is not included in the 300 odd (not 5000) references at the end of the book. What they did do was to carefully choose

a mixture of reviews of certain areas and detailed analysis of particular papers.

That was on page 4. Skip to page page 293 when the authors clearly state

We are NOT saying any of the following: 1. Autism is a condition caused by poor parenting.

That is concurring with Humphreys attack on parents who possess few or no heart qualities? It seems only right that ill-written books should be ill-read. But, bad as it is, The Myth of Autism does not deserve to be as badly read as it was by Tony Humphreys, if he read it at all.

UPDATE:

The Psychological Society of Ireland call for Humphreys article to be retracted.

THE PSYCHOLOGICAL SOCIETY of Ireland has criticised clinical psychologist Tony Humphreys over a controversial article on Autism Spectrum Disorders.
The article by Humphreys in the Irish Examiner last Friday was “not supported by the vast body of research” said Dr Michael Drumm, the head of the PSI.
Dr Drumm said that the asserts made in the article were “unhelpful and likely to cause upset” and that the article should be retracted. Humphreys is not a member of the PSI.
The article had been heavily criticised by Irish Autism Action, parents of children with autism and neuroscientist Simon Baron-Cohen, among others.
In the piece, Humphreys suggested that there was a link between autism and parents not expressing love and affection to their children. The Irish Examiner has since removed the article from its website.
The PSI said this afternoon that it does not support the assertions made by Tony Humphreys.
“Tony Humphreys’ assertions made in the article are not supported by the vast body of published research in the field of Autistic Spectrum Disorders and are unhelpful and likely to cause upset,” said Dr Michael Drumm, president of the PSI. ”It is hoped that the article would be retracted”.