Talk:Autism spectrum

A Consensus review paper you may find of interest

I just came across this paper while researching another related topic, Consensus paper: pathological role of the cerebellum in autism 2012 which could be useful when updating the article dolfrog (talk) 02:06, 2 September 2013 (UTC)

sign so bot won't archive. SandyGeorgia (Talk) 23:25, 2 November 2013 (UTC)

Fetal exposure to testosterone

I've removed this edit for discussion (source). If a secondary review, compliant with WP:MEDRS, can be found to back this text, it might be more appropriate to causes of autism. Unless important, recent reviews mention this, keeping the length of this overview article manageable is a concern. If no secondary reviews mention it, then whether it even belongs in the Causes sub-article is questionable. Is there a secondary review that mentions the testosterone theory? SandyGeorgia (Talk) 20:16, 12 October 2013 (UTC)

Here's the text that Sandy removed:

An extension, the extreme male brain theory, hypothesizes that autism is an extreme case of the male brain, defined psychometrically as individuals in whom systemizing is better than empathizing.<ref name=E-S-theory/> Certain evidence associates traits of autistics with fetal exposure to testosterone.<ref name = "Whiteley">Whiteley, Paul, et al. [http://www.la-press.com/gender-ratios-in-autism-asperger-syndrome-and-autism-spectrum-disorder-article-a1900 Gender Ratios in Autism, Asperger Syndrome and Autism Spectrum Disorder]. Autism Insights. 5 March 2010. Retrieved 12 October 2013.</ref>

I know some people don't like to talk about sex differences, but unless we have some reason to doubt the paper that I referenced, it has a place in this article. Sandy says this is a speculative primary source, but if you read the paper you see that it summarizes a large number of findings in various fields. I know some people have a knee-jerk reaction against the idea of sex differences, and I don't want to get into a fight, but let's humbly summarize what the expert say instead of picking and choosing ourselves what goes on the page. Leadwind (talk) 20:24, 12 October 2013 (UTC)

It works the other way, Leadwind. It is up to the person trying to insert "facts" to prove they are supported by the best sources and represent the best available evidence. It isn't up to others to prove they are poor or wrong. Unless reliable secondary sources on autism give WP:WEIGHT to the testosterone theory then it has no place in this article. Colin°^Talk 20:35, 12 October 2013 (UTC)

User:Leadwind, I have no "pony in the race" with respect to sex differences, but I would appreciate it if you would review WP:WIAFA and WP:MEDRS. Those two pages, in conjunction with WP:UNDUE (and concerns about length of this featured article) will help you understand what we might include here, or in daughter articles, or anywhere. SandyGeorgia (Talk) 00:03, 13 October 2013 (UTC)

First off I want to say that I am quite sympathetic to male brain idea. It fits nicely with a lot of data (I say this both as an experimental psychologist and the Dad of a kid with autism). That said, Colin and Sandy are right. We have to go with the secondary sources. We can't give undue weight to something that the secondary sources don't. Dbrodbeck (talk) 00:07, 13 October 2013 (UTC)

I also don't agree with this use of this source. This source doesn't appear to even be indexed in either PubMed or MEDLINE so its reliability is in question. It also appears to be a primary source; we already have lots of secondary sources providing theories about causes of autism. We should stick with the secondary sources, not primaries. Zad68 00:28, 13 October 2013 (UTC)

OK, sorry I got off on the wrong foot there. I'm used to sex-difference stuff getting deleted on political grounds, so that's what I assumed was going on. But if we're all friendly with the idea that fetal testosterone exposure creates inborn sex differences and if no one is trying to keep Baron-Cohen off the page, then my job is just to find a better source (if there is one). I'm familiar with the general WP standards, but the medical source policy is new to me. Leadwind (talk) 00:01, 14 October 2013 (UTC)

If you find a high quality, recent secondary review that discusses this, I doubt that you will find opposition to adding the text. But keep in mind that all medical content must conform to WP:MEDRS, but a featured article must additionally satisfy WP:WIAFA with respect to high quality sources, and we must also keep in mind due weight and the size of the article. You might want to also review WP:OWN#Featured articles ... it would be helpful if you discuss edits on talk, as there is generally a valid reason for exclusion/inclusion of most text here. As can seen from the section above, reasonable edits are accommodated :) Regards, SandyGeorgia (Talk) 01:09, 14 October 2013 (UTC)

Re this edit, this is an overview article, and an FA, which should rely on the highest quality recent secondary reviews. Could we find a place in daughter articles for Baron-Cohen speculation? Unless independent secondary reviews mention this, it might be better suited in a daughter article, and WP:UNDUE here. SandyGeorgia (Talk) 20:19, 12 October 2013 (UTC)

I moved this from the section above, as it seems to be more of same, and appears to have gotten lost in the shuffle. SandyGeorgia (Talk) 00:47, 13 October 2013 (UTC)

I saw this and I am unsure about it as well. Autism is not very well understood and there have to be dozens if not hundreds of theories regarding its origin and causes, it's not clear that this one particular theory is regarded highly enough to be included. The paper itself appears to be a primary source for the theory. Are there secondary sources that show this theory is well accepted? Zad68 00:53, 13 October 2013 (UTC)

autism

Moved from User talk:SandyGeorgia. [1] SandyGeorgia (Talk) 16:40, 14 October 2013 (UTC)

Hi Sandy. I agree about having high standards for material on the autism page. I hope we don't end up in a fight. Sometimes the editors I meet who revert sex-difference material can get really worked up. I hope this isn't one of those times. We both just want the best article, right? Leadwind (talk) 20:28, 12 October 2013 (UTC)

I'm sorry you have encountered past issues with "sex-difference material", but I have no such history, concerns or issues. I do expect text inserted into any (medical) featured article to comply with WP:UNDUE and to meet the sourcing standards at WP:MEDRS, and the criteria at WP:WIAFA. You have made some good suggestions for improvements to the leads, but discussion of other text would best continue on article talk. Regards, SandyGeorgia (Talk) 00:07, 13 October 2013 (UTC)

OK, thanks. Leadwind (talk) 03:13, 14 October 2013 (UTC)

You seem not to like Simon Baron-Cohen, but I don't see anything wrong with him. If you know something about him and why I shouldn't take him at face value, let me know. I don't want to take him seriously if he's a charlatan. Leadwind (talk) 05:32, 14 October 2013 (UTC)

@Leadwind: could you please stop making assumptions about other people's motives? As I have explained above, on medical FAs, our concern is that we use the highest quality, most up-to-date, independent, secondary reviews and respect due weight. SandyGeorgia (Talk) 14:24, 14 October 2013 (UTC)

On Talk:Autism, you said, "Could we find a place in daughter articles for Baron-Cohen speculation?" Baron-Cohen looks like a prominent autism researcher, and he's been working on autism for 30 years now, but you think his theories are "speculation." Is there a reason that I should dismiss his theories as speculation? If so, I'd like to know. Leadwind (talk) 14:57, 14 October 2013 (UTC)

Please confine article discussion to article talk, where everyone can participate. Please, again, stop ascribing motives to people's edits. The quoted sentence would convey the same message if I had typed "for speculation", "for the speculation", or "for this speculation". The "Baron-Cohen" was merely a qualifier for "the" speculation.

Once again, this is a broad overview article, and because it is an FA, we should be using the highest quality, most recent secondary reviews and giving due weight to individual theories. Giving prominence to any one theory promoted by any given research is undue and could (in some cases) also involve cherry picking of sources to promote individual views. As I said, could we find a place for this one theory promoted by one researcher in a daughter article, such as causes of autism?

Alternately, if you can produce a recent, high-quality review by an independent researcher that discusses this theory, we could incorporate what that secondary review might say. SandyGeorgia (Talk) 16:45, 14 October 2013 (UTC)

Please see also my comment dated 00:53, 13 October 2013 (UTC), just above this new section, that addresses this same question. Where is the high-quality, authoritative secondary source that demonstrates Baron-Cohen's theory is noteworthy enough for inclusion in this overview article? Adding--looking at the Simon Baron-Cohen article, it would appear his theories should hold some weight. Shouldn't it be easy to find a secondary source that provides an overview of current theories and which features Baron-Cohen's? Zad68 17:17, 14 October 2013 (UTC)

Adding ...we have already mentioned his theories in this article (see section below) ... but curiously, we are citing ... him. Leadwind, per due weight, please explain (according to independent recent secondary reviews) why we need more? SandyGeorgia (Talk) 17:39, 14 October 2013 (UTC)

@Zad68: our article on Baron-Cohen didn't include numerous book reviews, such as this one: Book review from Phenomenology and the Cognitive Sciences (in general, I would caution against basing decisions on what can be found on Wikipedia, which is a highly unreliable source). SandyGeorgia (Talk) 16:35, 15 October 2013 (UTC)

Thanks for the ping... I did search around after reading the article on him, and it seemed plausible if not likely his theories would be noteworthy. I wasn't saying based on the article we definitely should showcase his work, I just laid the question out there... Surely you know more about the sourcing on this than I do. Zad68 16:41, 15 October 2013 (UTC)

Unfortunately, the person who wrote a good deal of our featured content on autism is no longer with us, but Colin and I both had worked with him on featured content, and he was thorough, knowledgeable, and competent. It is unfortunate that he has been gone for about four years now, and a good deal of the high-quality and well sourced content that he wrote is now deteriorating (an example of the deterioration can be found at empathizing–systemizing theory, where well written and correct criticism of the theory has been removed, and a mess has replaced it). If something is claimed to be missing in this article, there is generally a reason, so I go looking for it. Leadwind's insistence on including Baron-Cohen encouraged me to go study up on SBC's theories. One review called the extreme male brain theory a "contentious subject" and one (rather extreme) review labeled Baron-Cohen a "charlatan" (the same word Leadwind used). Someone with better journal access than I have will be better able to explain how and why his theories are not widely accepted, but again, I believe those discussions belong at those articles, and including any more here on one of many theories about causes of autism is UNDUE. We are well served by following MEDRS and relying on recent high-quality secondary reviews. If Leadwind has an independent source that covers Baron-Cohen, discussion of that would be appreciated! SandyGeorgia (Talk) 17:14, 15 October 2013 (UTC)

Absolutely, independent authoritative reliable secondary sources need to be used to identify the most noteworthy theories and cover how well-accepted they are. The article currently cites two articles by Baron-Cohen, both monographs, for his theories. This is in my view an inappropriate use of primary sourcing. The E-S article abstract says "A new theory, the empathizing-systemizing (E-S) theory, is summarized" and the assortative mating article abstract says "evidence is reviewed for autism being the genetic result of assortative mating of two high systemizers". Even though the articles are labeled "Reviews" in PubMed, if they're laying out new theories being proposed and argued by the author in the article, they can't be used as secondary sources for those theories. The Wikipedia article doesn't even attribute these theories in-line to Baron-Cohen and really needs to, if it's going to cover them at all using primary sources. I'm not sure who put those in the article and when but I'm uncomfortable with how they're being used. Zad68 17:22, 15 October 2013 (UTC)

If SBC is a charlatan with a contentious theory, I'd be happy to write that onto his page and reflect it here. Two weeks ago, I didn't know who this fellow was, and I just like him because he sure seems like an expert. Maybe Sandy you can share links to those reports that you refer to. Since SBC's EMB theory reflects sex differences, that's bound to make him controversial among old-school blank slate proponents (by which I don't mean any WP editors). Is there more to the contention that that? We'd sure like to see it. If SBC turns out to be a charlatan, I'll eat all the nice words I said about him. We're are all about reflecting the views of the experts here, not our own agendas. Leadwind (talk) 15:29, 19 October 2013 (UTC)

Zad, you're absolutely right that the text needs to attribute these theories to Baron-Cohen. I edited the text appropriately. I trust everyone will approve. Leadwind (talk) 15:34, 19 October 2013 (UTC)

Empathizing–systemizing theory

PubMed has seven reviews on the topic. Curiously, every one of them is written by Simon Baron-Cohen. Could someone with journal access locate a review of his theories not written by SBC?

Alternately, here is the most recent, full-text review I could find that mentions sex-differentiation theories:

• PMID 23226953 2012

Autism affects males four times more than females,52 and the cause for this difference is not well understood. Several theories have been proposed, among which the involvement of the sex chromosome in the etiology of ASD, and the role of hormonal influences in utero (for review see ref 53). However, none of these theories has been confirmed yet. (citing SBC as the source, 53)

(That came from a PubMed search restricted to autism, free full-text, and review ... I have not searched further because there are gazillions of reviews and many reviews of many different theories ... confirming my conclusion that we should not give undue weight in this article to any one theory. Causes of autism would be where those could be explored, but again, based on independent sources.) SandyGeorgia (Talk) 13:56, 15 October 2013 (UTC)

Oh, my. On further follow-up, I see we once had a short, but clean article there, where we now have a mess. I see we have a similar mess at mind-blindness. Perhaps these discussions about these theories belong there. SandyGeorgia (Talk) 16:06, 15 October 2013 (UTC)

social cognition theories

Treatment of the extreme male brain theory and mind blindness theory gets the order backward. Simon Baron-Cohen proposed mindblindness first (1985), and later he and his team proposed EMP as a way to explain the nonsocial issues that mindblindness doesn't explain. Anyone mind if I straighten that up? Leadwind (talk) 01:26, 14 October 2013 (UTC)

I suppose you are talking about this text:

The empathizing–systemizing theory postulates that autistic individuals can systemize—that is, they can develop internal rules of operation to handle events inside the brain—but are less effective at empathizing by handling events generated by other agents. An extension, the extreme male brain theory, hypothesizes that autism is an extreme case of the male brain, defined psychometrically as individuals in whom systemizing is better than empathizing. These theories are somewhat related to the earlier theory of mind approach, which hypothesizes that autistic behavior arises from an inability to ascribe mental states to oneself and others. The theory of mind hypothesis is supported by autistic children's atypical responses to the Sally–Anne test for reasoning about others' motivations, (and the mirror neuron system theory of autism described in Pathophysiology maps well to the hypothesis.

What is your proposal for "straightening it up"? My query/concern is related to the sections above, where you appear to want to give undue weight to one set of theories promoted by one researcher (as you indicate here, these are Baron-Cohen's theories) ... it would be optimal to understand your sourcing and how you plan to "straighten this up".

sources 1) and 2) PMID 17115076 SandyGeorgia (Talk) 16:57, 14 October 2013 (UTC)

My proposal would be to reference Baron-Cohen himself describing first the mindblindness theory and then its replacement, EMB. It's an open question just how much weight this page should give to the director of the Autism Research Centre at Cambridge. Probably some. Let's say we don't use up any more space than what's here. I just rework it. Is there anything more I could do to address your concern that I'm not going to give too much weight to Baron-Cohen and his team of researchers? Leadwind (talk) 05:41, 15 October 2013 (UTC)

I'm struggling to see what is "backwards" about the quoted paragraph. It gives prominence to the newer theory. This isn't a history section, so the topics don't have to be in chronological order. The paragraph is already largely sourced to SBC rather than an independent source that compares and discusses several theories. Rather than fiddling with the word-order just to suit one person's taste as to what order to present things, perhaps we should be seeking a better source than one from 2009 that proposes a theory rather than independently discusses the theories. Without that, determining WP:WEIGHT is impossible, and per policy, must not be done by Wikipedian's trying to big-up one person's status. Colin°^Talk 07:25, 15 October 2013 (UTC)

I, too, am struggling to see what it is you want to fix, but your proposal for fixing it is not the way to go. The mind-blindness theory would optimally be explained in its own article (there is one, that is where the description belongs), and it should be described according to independent secondary reviews. We are already sourcing too much of SBC's own work to him, when it would better be described by independent sources. And I agree with Colin on the types of sources we should be finding-- there are plenty of high quality secondary reviews, and there is no need to rely on SBC's own representations of his own work (same for any researcher), rather than that work as reviewed by others. One is a concern for length, another is a concern for independent reviews that analyze someone else's work. I suggest that you propose your change on talk for discussion, but that you first produce the independent secondary reviews from which we might all work and understand which direction you want to go. (I am separately becoming concerned that we need to figure out, post-DSM5, how to distinguish this article from autism spectrum, as there is some overlap that is now confusing considering the new DSM5 definition). SandyGeorgia (Talk) 13:13, 15 October 2013 (UTC)

If you really prefer to put the earlier theory later and the later theory earlier (and you're not just stonewalling because you're sick of me), I can work with that. The section could be a lot more informative without switching the order in which the theories are treated. But the reader deserves to know why the mindblindness theory has been set aside in favor of EMB, for example. Leadwind (talk) 15:22, 19 October 2013 (UTC)

sex differences and ASD pages

Two weeks ago, I had no idea who Simon Baron-Cohen was, and now it looks like I'm his biggest champion. Weird. Here's what happened. I came to these pages innocently enough trying to learn the sex ratio of Asperger syndrome, and I was surprised to see this basic information left out of the lead. (Sandy was kind enough to add it at my request. Thanks, Sandy.) In looking at this page, at Asperger syndrome, and at Causes of autism, I saw more of the same. The sex bias is left out of the AS lead and touched on lightly in the body. As for SBC and his extreme male brain theory, it is repeatedly minimized. On this page and on Causes, the theory was undermined with OR (an unrelated article that in the editor's eyes, made EMB controversial.) On this page, the EMB theory is given vague treatment. For example, the text never explains why EMB replaced mindblindness as a current theory (e.g., what it explains that mindblindness fails to explain). EMB is not even in the "Causes" section of the page. It's under Mechanism, although the text never actually mentions a "mechanism." When I added a reference to a mechanism (fetal testosterone), it was removed within two hours (although the editor assures me that they have no problem with sex difference science, so that's apparently a separate issue). On Causes of Autism, the EMB theory is relegated to the "other in utero" section rather than getting its own section. In my recent investigations, I haven't some across any other theory as strongly supported as EMB, so it's weird that the favored theory of a prominent researcher and his team would be a side note. The E-S Theory page, where EMB is treated, features a long section criticizing the theory, and it's mostly OR.

We know that none of the current editors have an ax to grind when it comes to the science of sex differences, so all this bias against sex differences was either someone else's work or just inadvertent. Thanks for the help I've already gotten in setting this right. There's still more to do. Leadwind (talk) 15:19, 19 October 2013 (UTC)

I have now reviewed every paper I have access to (others undoubtedly have better journal access than I do), and the only mention of Baron-Cohen's theories I have found is the one listed above.

• PMID 23226953 2012

Autism affects males four times more than females,52 and the cause for this difference is not well understood. Several theories have been proposed, among which the involvement of the sex chromosome in the etiology of ASD, and the role of hormonal influences in utero (for review see ref 53). However, none of these theories has been confirmed yet. (citing SBC as the source, 53)

Several of the reviews that I have do mention other studies of Baron-Cohen's in passing, but not the specific theories referenced in the last few weeks of discussion here. The absence of SBC in our article does not seem inadvertent; it appears to be respectful of WP:MEDRS and WP:UNDUE. In fact, unless someone can provide independent sources discussing SBC's theories, based on the discussions here, at Talk:Asperger syndrome, Talk:Causes of autism, Talk:Empathizing–systemizing theory and at Talk:Simon Baron-Cohen, I am now concerned that we may be giving these theories undue weight in our articles. SandyGeorgia (Talk) 17:59, 22 October 2013 (UTC)

I have now found another source (which can't really be used here, but can be used to search for secondary reviews).

• PMID 22173769

is a primary source study of sex differences in autism which refutes EMB (extreme male brain):

• "Our results provide the first empiric test of the predictions of the EMB theory at the level of brain structure. No evidence of hypermasculinization was found, indicating the previously described behavioral and neuroendocrine effects do not map onto anatomic features in a straightforward way." "These interactions indicate that the sex-related differences in neurotypical controls are attenuated or absent in AS participants. However, we did not find that individuals with AS have a more masculinized brain, as postulated in the core hypothesis of the EMB theory."

There is a good deal of information in this article, which indicates that it should be possible for Leadwind to locate a recent secondary review of the proposed text additions. I do not have free journal access: I cannot do the work for you, but this primary source might point you in the right direction or help you locate a secondary review. SandyGeorgia (Talk) 18:29, 22 October 2013 (UTC)

Guideline and policy review

Leadwind, again, if you have a WP:MEDRS-compliant source that also meets WP:WIAFA, please provide it. We are discussing this now on five different article talk pages; I will attempt a summary once again:

1. We give theories weight according to independent reliable secondary sources (Simon Baron-Cohen is not independent on his own theories).
2. For medical text, WP:MEDRS in most instances prefers secondary journal reviews.
3. For Featured articles, sources must additionally conform with WP:WIAFA (high quality sources).
4. In sub-articles (like Causes of autism) we can explore in more depth individual theories, but in the broad overview main article, we take WP:UNDUE into account with respect to how much space to devote to any individual portion-- that is, length is a concern, and while the sub-article (causes) must still conform with relevant policies and guidelines, we can give more space there to exploring individual theories to the extent they are covered in sources that are compliant with our policies.

The relevant policies and guidelines have been explained now by several editors on several pages, so a review of WP:IDHT might also be helpful. SandyGeorgia (Talk) 17:59, 22 October 2013 (UTC)

I don't see anything on violence against autistic people

This seems like a major gap, one which deserves its own section on this page and quite possibly its own page. Ananiujitha (talk) 23:27, 22 October 2013 (UTC)

Sources on prejudice against autistic people

I just saw this first one today, and figured we should start a section on the issues:

• http://www.disabilityscoop.com/2013/10/23/children-quick-judge/18831/ Ananiujitha (talk) 17:43, 29 October 2013 (UTC)

That is a press report of one small study; please see our medical sourcing guidelines which call for secondary reviews, or in the case of a featuerd article, high quality, recent secondary reviews. I believe a secondary review for some text could probably be found; if you want to add the text, it is up to you to find it. SandyGeorgia (Talk) 17:47, 29 October 2013 (UTC)

Many of us don't have access to academic journals, so how would we find these sources? Ananiujitha (talk) 18:07, 29 October 2013 (UTC)

As an example of the kinds of sources we would use to support any proposed text, here is text from our article Asperger syndrome (AS), which uses sources that are complaint with our medical sourcing policies. The four sources used in our AS article are all specific to Asperger's; if you want to add equivalent text relating to autism more generally, sources of this caliber should be searched for.

The hypothesis that individuals with AS are predisposed to violent or criminal behavior has been investigated, but is not supported by data.(PMID 17030291 PMID 17805955) More evidence suggests children with AS are victims rather than victimizers.(PMID 12512398) A 2008 review found that an overwhelming number of reported violent criminals with AS had coexisting psychiatric disorders such as schizoaffective disorder.(PMID 18449633)

SandyGeorgia (Talk) 18:11, 29 October 2013 (UTC)

is this a good source for EMP?

This article (Evolutionary approaches to autism- an overview and integration ) from McGill looks pretty good to me as a source for information on Simon Baron-Cohen's extreme male brain theory. What do you folks think? Also, it seems that EMP is well-known [2]. The topic is contentious, but SBC's work is impressive [3]. Other researchers expand the theory to link it to schizotypy [4]. Anyway, my question is whether the McGill paper stands up to the high standards expected on this page. Leadwind (talk) 01:35, 29 October 2013 (UTC)

Well, I get a bit tired of people attacking who I am, as an autistic woman. Calling autism a disorder, or an effect of an 'extreme male brain,' definitely feels like a personal attack, and makes it harder for me to assess either the Wikipedia article or the linked pubmed article. Calling autism a 'lack of empathy,' given the multiple meanings of empathy, feels downright dehumanizing. As for specifics:

• I'm skeptical about the application of present sex-role stereotypes to all past societies.
• I'm not sure what the authors see as causes of differences in vagal nerve processes, or exactly what they see as the difference in the vagal nerve itself. If we accept these differences in the vagal nerve and in stress responses, that could explain digestive issues, which some autistic people have, but would it explain visual and auditory perception differences? or vestibular differences?
• I'm not sure what the epistatic theory is, beyond the idea that multiple genetic and epigenetic causes might interact.

As a non-expert on these theories: aside from the offensiveness, the article looks like a useable introduction to the first few theories, if not a complete explanation of them. Ananiujitha (talk) 02:19, 29 October 2013 (UTC)

To include text here about various theories, according to our policy on due weight, please locate secondary overviews that discuss the place these theories have in autism research. What you have found is a review focused on that one aspect (which might find a place in the Causes sub-article, might not, since a "journal dedicated to advancing student science" doesn't inspire confidence ...) but for this article, please locate general secondary reviews that are relevant to the due weight we would give any individual theory. That paper isn't it. As for the journal's stated goal of promoting students' work, are we to take seriously a journal which would print something like, "For women, empathizing may have been more important because of mothering, making new friends (women used to marry into new groups), gossiping, and inferring the thoughts of a possible mate (to discover whether he is willing to invest in offspring). So having an extreme male brain, a condition which we strongly associate with autism, may have had practical advantages given demands of ancestral times." SandyGeorgia (Talk) 18:14, 29 October 2013 (UTC)

Genetic causes

Copied from User talk:SandyGeorgia:

Hi Sandy, I am not particularly emotionally tied to the topic, but what struck me as incorrect materially was the following: Autism has a strong genetic basis, although the genetics of autism are complex and it is unclear whether ASD is explained more by rare mutations, or by rare combinations of common genetic variants.[5] I check the reference and the most recent citation was from 2007 and much more information was draw from earlier than 2007. If you check the Mayo Clinic or another other reputable medical source, discredits this sentence. For instance check http://www.mayoclinic.com/health/autism/DS00348/DSECTION=causes or recent research http://www.health.harvard.edu/books/the-autism-revolution. It is misleading to write there is a strong genetic basis. The truth is the cause is unknown. Further under controversies, it would be more up-to-date to state there is actually quite a bit of consensus around environmental causes. http://www.scientificamerican.com/article.cfm?id=autism-rise-driven-by-environment. and of course you could cite the Lancet for the vaccines.

GMO should be included in the suggested causes. The correlation is quite convincing. — Preceding unsigned comment added by FrenchFrench99 (talk • contribs) 01:52, November 1, 2013 (UTC)

I am aware that some do not favour compiled research paper collections as thye may be used to present a personal preference. You may find some of the research articles included in my PubMed Autism ASD review paper collection of some interest, including some more recent reviews regarding genetics. dolfrog (talk) 17:00, 1 November 2013 (UTC)

Mayo clinic is not a reliable source nor is "the autism revolution". Please read WP:MEDRS regarding what sort of sources we should be using. Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:44, 2 November 2013 (UTC)

Hi Doc the citations used in this article regarding most of the content are extremely dated, and requires a radical review. I came across these papers recently which may provide more detailed and research based insight regarding some of the genetic issues A genome-wide scan for common alleles affecting risk for autism. 2010 and Individual common variants exert weak effects on the risk for autism spectrum disorderspi, 2012. Obviously there are more recent related reviews. dolfrog (talk) 13:51, 2 November 2013 (UTC)

Dolfrog, I've got my hands pretty full and don't have time at the moment to take on the huge project that is needed here, but in addition to routine updates, we still have to address the issue of DSM5 (that is, what are we going to do about this article in relation to autism spectrum) so it's hard to know where to start. Do you want to begin proposing text with sources? The commentary from the editor above was off ... which doesn't mean we don't need to update-- I just don't have the time. SandyGeorgia (Talk) 13:58, 2 November 2013 (UTC)

Hi Sandy I have noticed how busy you have been on various other articles in recent times. Unfortunately my copy editing / text composing skills are next to zero, due the the limitations imposed by the cause of my dyslexic symptom. Even creating this small contribution has taken quite sometime, due to my word recall (finding the right words) and sequencing issues. And as you are no doubt aware helping to run the UK support organisation for my own disability is quite time consuming. Which means i can always help provide the supporting citations or citations that can be used to update an article, but I am not really able to contribute any text. dolfrog (talk) 15:03, 2 November 2013 (UTC)

Ah, I see ... well, I didn't want you to think I was ignoring your sources (I browsed them yesterday and found lots of good stuff), but I also have limitations, not only prose but access to sources not to mention how busy I am, and an even bigger concern about how we are to restructure the entire suite of articles to account for DSM5 ... and who and how to find the time to fix it all. SandyGeorgia (Talk) 15:09, 2 November 2013 (UTC)

Employment

Broad overview article, size concerns. Does this text belong here or at sociological and cultural aspects of autism? And is the source about autism or schizophrenia? SandyGeorgia (Talk) 21:28, 3 November 2013 (UTC)

Seems to be a new area of research have a look at A Systematic Review of Vocational Interventions for Young Adults With Autism Spectrum Disorders dolfrog (talk) 22:53, 3 November 2013 (UTC)

Wonderful! Since that has free full text available, and is specific to autism, I suggest we use it instead of Cochrane. So, do we think some text about employment belongs in this article, or at sociological and cultural aspects of autism? The review concludes:

In the current review, individual studies of different on-the job supports reported increased rates of employment in the community relative to those without on-the-job supports; however, given the methodologic limits of such studies, the strength of evidence (confidence that future research will not change our understanding of the effect) for the effect seen is insufficient. Similarly, despite positive results related to other outcomes (ie, quality of life, autism symptoms, cognitive development) reported in individual studies, the poor quality of the studies, assessment of unique outcomes in each study, and lack of replication lead to insufficient strength of evidence until further studies are conducted that may confirm the observed effects. Research to quantify the degree to which these interventions are effective, under what specific circumstances, and for which individuals with ASD is critical for the growing number of adolescents and young adults with ASD who are approaching the transition to adulthood.

SandyGeorgia (Talk) 22:58, 3 November 2013 (UTC)

Sandy, I do think the information on employment prospects and potential intervention belongs here because it has to do with prognosis for a condition that impacts social skills. In addition, I added the Cochrane Review specifically in compliance with WP:MEDRS as this is a preferred source. There is no particular need to include free text articles, although as a user I appreciate being able to see the full reference myself. I think it's okay to add that but I don't see any reason to remove the Cochrane reference.Benutzer41 (talk) 23:43, 3 November 2013 (UTC)

1. It may belong here, but that is a matter for consensus, and if it does belong, it would be part of a section titled "Society and culture", per WP:MEDMOS (not as part of Prognosis).
2. Is that review specific to autism, because the title did not imply that and free full text is not available. The title is "Supported employment for adults with severe mental illness ... ".
3. The source Dolfrog supplied is not only recent, but a) specific to autism, and b) free full text is available, which is a service to our readers, that is more important than promoting Cochrane, as good as Cochrane may be.
4. The conclusions of the review Dolfrog found seem a bit at odds with the text you added sourced to Cochrane, so that will have to be sorted when we decide what to add and where.

There is no reason we must prefer Cochrane even if it is in compliance with MEDRS; that Cochrane provides high quality, recent secondary review is only one factor in the discussion. All other things being equal, we would prefer to offer a source to our readers they can access. Why do you believe a Cochrane survey on mental illness in general is superior to a specific autism survey, and how do we account for the differences in conclusions between the two? The review provided by Dolfrog seems to provide conclusions that would be more useful to our readers: a statement that job supports improves employment outcomes isn't ... well ... very useful. It's kind of "doh", while the review Dolfrog found gives us more to work with. Also, please review WP:OWN#Featured articles; it's always helpful to first discuss text on FAs, and please follow the citation style used here, since FAs must maintain consistent citations (WP:WIAFA, WP:CITEVAR). This article uses vcite journal, and includes PMIDs. SandyGeorgia (Talk) 02:08, 4 November 2013 (UTC)

1. I used Cochrane because of WP:MEDASSES, which states "The best evidence comes primarily from meta-analyses of randomized controlled trials (RCTs).[2] Systematic reviews of bodies of literature of overall good quality and consistency addressing the specific recommendation have less reliability when they include non-randomized studies.[3] Narrative reviews can help establish the context of evidence quality. Roughly in descending order of quality, lower-quality evidence in medical research comes from individual RCTs; other controlled studies; quasi-experimental studies; non-experimental, observational studies, such as cohort studies and case control studies, followed by cross-sectional studies (surveys), and other correlation studies such as ecological studies; and non-evidence-based expert opinion or clinical experience. Case reports, whether in the popular press or a peer reviewed medical journal, are a form of anecdote and generally fall below the minimum requirements of reliable medical sources". That would make a Cochrane review of RCT or quasi-RCTs higher quality than a single study. Having said that, I have no objection to adding the free text citation from Dolfrog.

2.I did not consider this a significant change. However, as part of this discussion, I see that this content could be added to existing content following this sentence under "Management": "After childhood, key treatment issues include residential care, job training and placement, sexuality, social skills, and estate planning." or under Prognosis "A 2008 Canadian study of 48 young adults diagnosed with ASD as preschoolers found outcomes ranging through poor (46%), fair (32%), good (17%), and very good (4%); 56% of these young adults had been employed at some point during their lives, mostly in volunteer, sheltered or part-time work.[159] Changes in diagnostic practice and increased availability of effective early intervention make it unclear whether these findings can be generalized to recently diagnosed children." I had specifically added content which used more recent information and reviews instead of single studies. Since aspects of employment were already embedded in this article, it does not necessarily need to go under "Society and Culture". However, if consensus is to add that section to this article, I am happy to do so. What should it be? Embed in Management, Prognosis or start Society and Culture?

3. Check this out. Postsecondary employment experiences among young adults with an autism spectrum disorder at http://www.ncbi.nlm.nih.gov/pubmed/23972695.I think it is another good recent article to cite although free full text not available. I agree that the supported employment article from Cochrane, which does include reference to autism, is not nearly as good as one solely about autism, however I had already done the research on employment stats and selected that article as the highest quality. I think the review from Dolfrog is a good start. I am less concerned about research on supported employment than I am about the research on employment issues for people with autism and citing research indicating status of evidence on interventions.Benutzer41 (talk) 23:03, 4 November 2013 (UTC)

1. WP:MEDRS, together with WP:WIAFA in this case, calls for recent, high-quality, secondary reviews. Both Cochrane (from you) and A Systematic Review of Vocational Interventions for Young Adults With Autism Spectrum Disorders (from Dolfrog) are high-quality, recent secondary reviews.

But Dolfrog's is additionally freely available, and specific to autism, which (all other things being equal) makes it a better source.

The Cochrane review you supplied is PMID 24030739 and Dolfrog's is PMID 22926170. Referring to sources via PMID makes everything much eaiser :)

This page helps explain how to interpret and use MEDRS, and gives you more info about how to use PubMed and identifiers (PMIDs): Wikipedia:Wikipedia Signpost/2008-06-30/Dispatches. SandyGeorgia (Talk) 02:16, 5 November 2013 (UTC)

2. The information now in Management and Prognosis is about Management and Prognosis. Before deciding where to add text, it would be helpful to craft some useful text, preferably from Dolfrog's source, since the text that you had added from the Cochrane review didn't really add anything to the article. In a featured article, almost everything is significant :) Featured articles have to stay in compliance with What is a featured article. If you could take a moment to read the section just above this one, you'll see that everyone working on these articles is quite busy (and sometimes quite tired, as I am now). Several of us don't have time to compose and propose new text just this moment, but I suggest that composing a sentence of two from Dolfrog's source, and proposing it here on talk, will be the most useful avenue. SandyGeorgia (Talk) 02:16, 5 November 2013 (UTC)

3. The link you gave goes nowhere (probably because you ran the sentence together which broke the link). I believe you meant PMID 23972695 ... which is not a secondary review, it is a primary source (non-MEDRS compliant). It is not a source we can use; it is a study which has not been reviewed by other sources. If you want to propose text, I suggest the best source is PMID 22926170. SandyGeorgia (Talk) 02:16, 5 November 2013 (UTC)

Entire article is hateful and treats autism as a disease

I can't see where to even begin to address this. The language of "disorder," "cure,: "recovery," and so on all assume that our differences imply something wrong with us. Unfortunately, the neutral point of view policy doesn't explicitly address articles which are hateful to the minorities they are supposed to cover, except for articles about religious minorities. But to have an article about autism which only discusses the views of allistic people in the medical community, and doesn't discuss the experiences and views of autistic people about being autistic seems like a violation of the spirit of the policy. Ananiujitha (talk) 16:55, 24 November 2013 (UTC)

We are following sources. There is no hate here, you are reading that into it I think. If you have sources bring them here please. Dbrodbeck (talk) 17:00, 24 November 2013 (UTC)

WP:NOTAFORUM; please base your proposed revisions on reliable sources. I have shortened your section heading because it runs off the page; I hope you don't mind. It is unsightly to start adding multiple daughter articles to the hatnote, and if we add one, they can go on forever. I made this change;[5] what do others think? It reduces the hatnote to one article, which really is the one summarized here, and puts the other two links inline. SandyGeorgia (Talk) 17:53, 24 November 2013 (UTC)

I know there are special requirements for sources here. I don't know what they are. I don't have access to the resources I'd need to address this, either. It should be a basic principle that, when we have an article about a group of people, we should try to include material from the perspective of the group. Here we have one that is about us, without us. Ananiujitha (talk) 18:22, 24 November 2013 (UTC)

The article says: "Most children with autism lack social support, meaningful relationships, future employment opportunities or self-determination[clarification needed].[28]" What does the source say about some children? Some children may lead very normal lives. A bit more clarification about "some children" will improve Autism#Prognosis. QuackGuru (talk) 19:31, 24 November 2013 (UTC)

The link was dead, so I googled, and found and linked a new one. The paper is long, I don't have time to read it, and that section was most likely written by Eubulides in 2007 or 8. From my preliminary scan of the text, if you want a source that verifies something like "some children may lead very normal lives", you might want to look elsewhere. I have not seen such a source for children with autism, but Dolfrog knows the literature well. SandyGeorgia (Talk) 19:55, 24 November 2013 (UTC)

The current text is about "Most children".[6] I think the paragraph should also say something about "Some children". That was my point. QuackGuru (talk) 20:05, 24 November 2013 (UTC)

I understood your point. The source does not discuss "some children" as far as I could tell based on a quick scan, and if you want to include a statement of the nature you describe, you will need to find a source. I don't think that one is it. I only scanned it, but that source seems very focused on QoL measures, with conclusions about those specific measures for "most" children, and nothing else that I saw on quick scan; hence unlikely to be where you might find what you're looking for. You are welcome to find sources that will support whatever you want to add: I don't have time to read that full report, but scanned it to let you know your search might be more fruitful elsewhere. SandyGeorgia (Talk) 20:37, 24 November 2013 (UTC)

Hi Sandy you might like to have a look at this journal special edition Discussion Meeting Issue ‘Autism and talent’ May 2009 and there are more I will have a look around and get back later dolfrog (talk) 21:07, 24 November 2013 (UTC)

I don't have time, Dolfrog, and I'm not likely to for a long time. If people (like QuackG) want text added, they need to consult the sources themselves. SandyGeorgia (Talk) 21:19, 24 November 2013 (UTC)

I put in the "clarification needed," because I'm not sure what this means about lacking self-determination. Is this supposed to be due to being autistic or is this due to being denied self-determination [being institutionalized, being rendered dependent, etc.] for being autistic? Ananiujitha (talk) 21:08, 24 November 2013 (UTC)

It's pretty clear to me that without the addition qualifiers (of being institutionalized, etc) that it probably means exactly what it says. You are welcome to read the lengthy journal source that is linked that I've already told you I don't have time to read. Most of this text was written by a long-gone editor, so if you have questions about sources, look 'em up. SandyGeorgia (Talk) 21:34, 24 November 2013 (UTC)

Checking the article, the authors seem to mean that many autistic people are denied opportunities for self-determination. Also, I think exactly what it said was exactly unintelligible. Anyway, thanks. Ananiujitha (talk) 22:42, 24 November 2013 (UTC)

More perspectives on characteristics?

Would it be possible to include more of autistic people's views in the characteristics section? [There is one part citing Temple Grandin] I know there are discussions of common issues and even alternate diagnostic criteria, although most of these discussions are in blogs, not reliable sources. Ananiujitha (talk) 21:25, 24 November 2013 (UTC)

There are no secretaries here. This is the fourth request in a few hours by you and QuackGuru, whereby you expect someone else to look at sources and do the work. This is a Featured article. It has to conform to WP:WIAFA, that is, it must use high quality sources complaint with WP:MEDRS. We don't source anything just about anywhere to blogs, much less in a featured article. If you want to propose text, find the sources, read them, and propose text based on them. Otherwise, this is WP:NOTAFORUM. Unless there is a journal published secondary review of her work, it is unlikely that anything from Temple Grandin will find its way in to this article, but find the source and propose it if you want it considered. The burden is on the person wanting to add text to provide the source, and all of our time will be much better spent here if, when you propose text, you do that because you have a high quality source that supports the text you want to add. SandyGeorgia (Talk) 21:36, 24 November 2013 (UTC)