Tuesday, February 24, 2009

Autism: Tragedies and Treatments

As the eve of the Oscars quickly arrived and simultaneously passed in a puff of star-filled smoke, we are merely left with images. The images of impeccably dressed men and women exuding sheer class and pulchritude will be soon forgotten. The talk will subside as people care less and less about which actress wore which gown and the like. These are frivolous topics that we should forget. Unfortunately, as time takes its course, people tend to also forget and cease to speak about more important issues and tragedies circulating in the media. One such story that has slipped through the cracks of the news is the story of the tragic death of Jett Travolta, son of John Travolta (see image right). The travesty was at the epicenter of hot controversy and debate in the realm of autism, as critics believe his death may have been preventable and possibly attributed to the religion notoriously known as Scientology. As a result, this week I resolved to indulge my opinion by commenting on a post titled “May He Rest in Peace.” This post can be found at "The Joy of Autism" and is written by a celebrated blogger in the field of autism, Estée Klar, who assumes an impressive following of a quarter of a million readers. As this post further triggered my curiosity with reference to treatment methods for children with autism, I also consider a second post, titled “New Medication Ineffective for Autistic Symptoms.” Lisa Jo Rudy, a professional writer, researcher, and consultant in the field of autism, posted this in her “Autism Blog.” Both posts effectively provoke questions and concerns relevant to developmental psychology and shed light on its relationship to the complex disorder known as autism. My responses can be seen either below, or directly at the blogs at which I commented on.

"May He Rest In Peace"
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In reading this post, I am truly enlightened by the ideas that you provoke in your readers. Like you, I agree that it is “dangerous to humanity” the way in which people identify autistics—normally to batter and criticize, and rarely to ruminate the endearing and astounding qualities they bring forth. It is human nature to conform to what is considered “normal” and yet the term normal is in itself obscure. Who has the right to decide what is normal? We once punished and humiliated those who wrote with their left hand, deeming it a sure sign of the devil. However, in contemporary times, whether you’re a “lefty” or a “righty” does not matter. It is unsettling to think that society could be so ignorant, but in many ways, we still are. We create our own perceptions of what is normal or “right”. I agree that there is nothing wrong with the flapping and flailing behavior commonly associated with autism. The fact that humans can flap and flail should mean that it should not be looked upon as weird or unusual. I also believe that as humans we have to learn to accept and we must criticize less. I applaud your focus on eliminating stigmatic labels.

I do wonder though, whether you truly consider autism activists in the wrong for questioning the nature of Jett Travolta’s untimely death. While I concur that doctors and psychiatrists are quick to diagnose and medicate children, this doesn’t necessarily mean that all treatments or medications are harmful. Says the New York Post: “According to the Church of Scientology, people with disabilities like autism are classified as "degraded" and capable of curing themselves by working harder on the church's teachings.” I’m not blessed to know anybody specifically with autism, and so I turn to you and wonder if you think it is possible for an autistic child to be “cured” through religious teachings. The article in the New York Post also mentions that the Travoltas continually “denied speculation that their son exhibited autistic symptoms” and a result failed to seek treatment or evaluation for their son, instead attributing his symptoms to Kawasaki syndrome. The Los Angeles Times however reports, “there is no link between Kawasaki and seizures. However it is reportedly common for sufferers of autism to have seizures if they are left untreated.” This brings me to my last concern. If Jett was indeed autistic, the Travoltas could have taken initiative to use their fame and notoriety to catalyze support and awareness for the cause. Perhaps choosing not to “label” their son as being autistic was not to their advantage. I simply wonder whether there is a fine line between not desiring to label and stigmatize, and causing potential harm to the person you so love and cherish. Could this have been avoided?

"New Medication Ineffective for Autistic Symptoms"
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Upon reading this brief and yet informative post concerning the nature of drug treatments available to those with Autism, I am very intrigued with one particular idea that you present. I too share your fascination with the ability of placebo subjects to exhibit improved behavioral symptoms. It is especially interesting given the nature of autism and the notion that, as you describe, “it’s unlikely that children with autism would fully understand the intent of the treatment.” Given the limited number of FDA- approved medications available in treating autism (see image left), it would be detrimental to both the fields of science and autism to conduct studies analyzing the placebo effect as it pertains to the amelioration of autistic symptoms. From a social-psychological perspective there exists a theory known as the self-fulfilling prophecy wherein, “an originally false social belief leads to its fulfillment… When a self-fulfilling prophecy occurs, perceivers’ initially erroneous social beliefs cause targets to act in ways that objectively confirm those beliefs.” In lieu of this, I agree with you that the ability for autistic kids to improve their behavior can be directly attributed to how parents’ expectations may alter their perceptions of their child. I wonder then, if perhaps this can be considered a self-fulfilling prophecy, and if so, if that may be a potential treatment for autism. Is it possible that if a “parents’ expectations can color their vision of their children”, that in consequence the child could actually improve? Meaning, rather than the parents being the core of the placebo effect (as they are the ones that report their child’s improved behavior), is it possible that the child could actually improve as a result of the way their parent’s interact with them?

On February 18th, The Salt Lake Tribune reported that a bill requiring insurance to cover the treatment of children with autism won the Senate’s tentative approval. The article states, “families are paying for insurance policies that refuse to cover autism treatment.” Although the bill finally won the Senate’s hesitant approval—that it took this long is very telling of how difficult it is to obtain and undergo treatment for autism, especially for those without the funds to do it. Furthermore, there are various approaches towards treatment, and says the NYTimes.com, parents are “Trying Anything and Everything for Autism.” It is evident that there remains some time before a clear answer is provided, but still the question lingers concerning the placebo effect and its implication towards the effective treatment of autism.

Tuesday, February 17, 2009

Octomom versus Doctor: Are Either to Blame for the Family of Fourteen?

Imagine the shock that Nadya Suleman, age 33, must have felt upon hearing her obstetrician exclaim—“There’s an H!” It was at that precise and unequivocal moment on January 26th 2009, that the mother realized she had just given birth to not one, not two, not five, but an astounding eight babies (see image right). The woman with the seemingly interminable ability to have children would bring home her litter of eight (A through H) to join her other six offspring, all of whom fall under the tender age of eight years old. While on the surface this story harbors all of the endearing qualities of a heartwarming tale—even a miracle some argue, it is a far cry from that. The octuplets have been repeatedly featured in the headlines in the past week, as their birth has sparked much controversy nationwide. The focus is concentrated heavily on the mother, Ms. Suleman, who conceived these children via in vitro fertilization (IVF) all the while single and unemployed. Also under the microscope is Suleman’s fertility doctor, Dr. Michael Kamrava, who enabled the mother to continue to undergo IVF treatments even though he was well aware of her financial status and burgeoning family. Although it is clear that Nadya Suleman has made poor decisions which have compromised the well being of those around her, the fertility doctor is just as culpable for his part in exacerbating the already ominous situation. While Suleman acted wholly irresponsible, Dr. Kamrava operated out of his own interest and greed, using her fecundity to boost the overall fertility rate of his clinic.

In vitro fertilization is a procedure “designed to enhance the likelihood of conception in couples for whom other fertility therapies have been unsuccessful,” states the Overview for IVF Patients. The industry has doubled in size since implemented in 1996, and more than 50,000 children a year are born as a result—a booming 1 billion dollar business. An explanation of the IVF procedure in summary includes the retrieval of the woman’s egg, the collection and preparation of the sperm, the insemination of the eggs and embryo culture, and finally, the transferring of the embryos into the uterus. IVF is a complex process, wherein each stage of the procedure is associated with specific risks. It is important to note that the Overview specifically designates IVF as a procedure designed for couples who cannot have children, not for single mothers already caring for six children. Fertility clinics are not simply places to create a personalized soccer team, and in undergoing the procedure, the mother puts herself and her children at risk each time she assumes treatment. Yet from this, a significant question is raised—is the nation merely judging Suleman because she chooses to raise her children single-handedly and without the help of a man? How is it politically correct or fair that in vitro fertilization is outlined as being specifically couple-oriented? The procedure discriminates against women as it intimates that a woman cannot raise a family on her own ability. And those on Nadya's side agree with her statement: "I feel as though I've been under the microscope because I chose this unconventional life." For instance, Jennifer Block of the Guardian UK believes, "Couples who've had multiples haven't suffered the same scrutiny because they are couples. The media went easy on the McCaughey family, who had septuplets in 1997, and barely acknowledged the Chukwus, who had octuplets in 1999. And then there are the Duggars who have 18 children and their own reality TV show." Furthermore, another Octomom supporter blogs, "We have something called reproductive freedom in this country. If you tell a woman that she can’t have 14 children, regardless of her circumstances, then you leave the door open for telling all women when and how they can give birth in general. You can forget about making your own decisions about abortions, birth control and, yes, fertility treatments."

It appears then the single mom does have some advocates to root her on and have faith in her ability to provide. Unfortunately though, Nadya Suleman is by no means Angelina Jolie, her hypothesized role model. Suleman does not have millions of dollars, a property the size of a small country, a wealthy husband, nor an army of body guards and baby nurses to help care for her brood. The single mother lives modestly in a small house that barely even fit the first of her six progeny and receives federal assistance for three who are disabled with autism. Ms. Suleman already owes a whopping $50,000 in student loans and was in the same situation when deciding to undergo IVF yet again a year ago (using the last of a life's savings), placing the yearning for a child-filled utopia before her existing children’s necessities. Never thinking logically of how to care for the babies financially or emotionally, Suleman placed her faith in a far-fetched dream: “I will feed them. I will do the best I can. In my own way, I do believe wholeheartedly that God will provide." With no money, and holding firmly to a childhood fantasy of a house filled with cherubic faces, she is sadly twelve arms short of reality. In opposition to Suleman and to the blogger's statement above, pro-choice psychiatrist Carole Lieberman argues, "Freedom, including women’s reproductive freedom, entails responsibility. Nadya is the poster child for women’s reproductive irresponsibility. Prochoice essentially means that she had the choice over her body in regard to reproduction. She had several options, including donating her frozen eggs or giving the babies up for adoption.” In essence, Nadya Suleman has been designated one of the most selfish mothers to date by many.

Although it is clearly ludicrous and irresponsible for a single woman living off welfare to continue requesting the IVF treatments, it is ultimately the doctor who should have regulated and firmly put his foot down. Like many mothers who have acquired the biologically evolved need to protect and care for all their children, Suleman simply did not want to leave the unused embryos in the fertility clinic. She thought they deserved the chance to live and thus decided to implant what was left. Upon realizing how many survived, she was astounded like the rest of the world. When this phenomenon occurs, doctors normally perform a “selective reduction,” wherein by injecting a couple of the fetuses one can increase the chances of more healthy babies instead of a miscarriage. So, why did Dr. Kamrava not undergo the routine procedure? Apparently he is not one to follow rules. According to the American Society for Reproductive Medicine, the guidelines for in vitro fertilization in women under 35 encourage the transfer of only one embryo, with two being the maximum (see image left). Dr. Michael Kamrava implanted six embryos into Nadya Suleman, two of which resulted in twins. The real difficulty is that concrete, enforceable laws do not back these guidelines and regulations. Says the NewYorkTimes, “The Center for Disease Control and Prevention has a surveillance system that collects data on fertility clinics, but reporting is voluntary and there are no government sanctions for not reporting. As a result, experts say many doctors are still implanting too many embryos to increase the chance of pregnancy." Apparently they are doing this in order to boost their clinic's fertility rates, but doctors, such as Dr. Potter of the Huntington Reproductive Center, are supposed to make the final decision regardless of a patient’s wishes: “We have an obligation to protect the patient and not let the patient do things that are unreasonable." And yet, Dr. Kamrava did not abide by this descriptive norm, instead taking advantage of Suleman and her robust fertility. In documents recovered by the Los Angeles Times, it was found that the doctor's clinic actually has one of the worst success rates for pregnancy in the entire country, with Ms. Suleman's children representing a "sizable portion" of his clinic's fertility increases in the last several years. It is no wonder he turned a blind eye against what was surely going to be disastrous and irresponsible. And where he should have selectively reduced Suleman's embryos, he failed to, probably relishing in his success of producing octuplets. Meanwhile, Nadya and all of her babies could have easily died from the high-risk pregnancy. Speaking of Kamrava's participation in the fiasco, embyrologist John Scodras notes, "That's a dangerous thing to do." And indeed it was, on both the mother and the doctor's parts. Both acted selfishly and without thinking of the consequences. Nadya Suleman failed to take into consideration the effect that an additional eight children could have on an already large family. She did not care that she could potentially be bringing disabled children into the world, simply desiring to be surrounded by children, even ones she could not afford or pay individual attention to. Dr. Michael Kamrava similarly thought of only himself and his personal needs and potential gains when playing the role of the scientist-God. He broke rules and took risks that could have cost him the life of a patient and numerous children. Neither parties feel that they are in the wrong and yet the whole country is outraged at both their carefree and egoist attitudes. It is unfortunate that fourteen beautiful children are going to have to live with these unfortunate and avoidable mistakes.

Sunday, February 8, 2009

A New Blog About Developmental Psychology: Gaining Entry Into the Psychology Blogosphere

Greetings to the developmental psychology world— and to those people who have merely stumbled upon this newly born blog, I hope that they will be interested as well. As a brand new member of the blogosphere, I would like to introduce myself. My name is Farrah Aldjufrie and I am a psychology major attending the University of Southern California. In creating this blog, I aim to explore current and important issues in developmental psychology. To preserve the goal of remaining up to date in the psychology world, I have embarked on a journey to discover the most relevant and dynamic resources on the Web, and have conveniently placed them in the linkroll (to the right). To find these resources I left no leaf unturned— starting from larger and broader search engines such as Google and Cuil, and then funneling down to explore narrower websites— organizations and associations dedicated precisely to developmental psychology. In between I scoured through directories, library indexes, governmental and health-affiliated websites, and vital news sources— all which led me to various astounding developmental psych web resources (like the Child Development Institute). Rather than just focus on websites, I similarly chose a few developmental psychology blogs as sources of information (such as The Human Odyssey).

In carefully and meticulously choosing the websites for the linkroll, I selected only those sites of utmost quality. I did this by employing the Webby Awards criteria—a standard of judging and selecting high-value websites. I chose those sites that displayed a wealth of knowledge and those that were visually pleasing to the eye and all the while, navigable. The sites on the linkroll meet these criteria and also entail sufficient interactivity and high authority: they are affluent organizations (developmentalpsychology.org), associations (American Psychological Association), and research centers, and therefore what is written on them can be trusted. These websites demonstrate a pleasing and informative overall experience.

As per craftily selecting the developmental psychology blogs, I followed what is known as the IMSA criteria, which allows one to carefully evaluate and assess different blogs. Anyone who is anyone can have their own blog so it is important to make sure that a blog is written by someone who cites their information. It is also important to look at who comments on their blog, who follows their blog, and if their blog is of influence. It is essential to look at the blog’s content, but also, at how the blog is written and how often the blog is updated. The best blogs are ones that are ‘alive’ and interactive, with valuable viewpoints that are forward and open about its biases. Blogs that are visually pleasing are important as well (note the strong aesthetics of the blogs in the image to the right).

I hope my readers will find this to be a strong and relevant blog in the contemporary research and academic world of developmental psychology.
 
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