Wednesday, 11 December 2013

Assessment Week at School and Cognitive Enhancement in Autism

 In earlier posts I have touched upon the problems of clinical trials in autism:-
·        Highly subjective, or ineffective, rating scales for autistic behaviours

·        Lack of biomarkers, or any other marker, to target a specific sub-types(phenotypes of autism

·        Very small sample sizes and often amateur execution, meaning the results cannot be replicated

I think one of these problems has a ready solution, at least for verbal primary school children with ASD. 

Assessment Week
Last week, Monty aged 10 with ASD, had assessment week at school.  The academic subjects he participates in, are Maths, English and Science.  We have chosen to skip Geography, History and French.  Monty already has another second language.
Following the tests at school, I decided to make a test of my own.  I stopped all of my therapies and waited to see what would happen and if anyone would notice.

The first therapy I had to reintroduce was bumetanide, which in his case makes him far more aware of himself and his surroundings; it makes him more “present”.  The reason for this was, for the first time in years, on day one, he forgot to go to the toilet and peed in his pants.  A coincidence?  I think not.  Also, when I told him that I was going out, instead of the expected “see you later, Dad” I got “see you Monday”.
Then the next day having restarted bumetanide we drive to school.  I hear lots of relevant comments like “There’s a Peugeot lion taxi car”, “The soldier has a gun, that fires bullets”.  The day before there were no comments at all.

But the day at school was not so good; all the stereotypy with his hands and fingers returned, so while the day was not hard for his assistant, she said it was hard for Monty.  He was commenting, like the things he could see through the window of his classroom, but work was not good.  Handwriting degenerated to oversized sloppy writing, that did not follow the lines on the paper. In the afternoon, I reinstated NAC, just in time for the arrival of his assistant who works with him at home, following an ABA-style programme.  During the rest of the afternoon, all stereotypy with his hands and fingers disappeared, just as expected.
Today, I met the school teacher and not only were his grades As and Bs, but he finished his tests much faster than most of the other children.  This is remarkable, because he has never received any real academic grades before; the teachers did not think it fair to give him grades.  I should point out that Monty is at least 2 years older than his classmates; but then he was pretty much entirely non-verbal until he was 4 years old, so he has lost a lot of learning time.

The relevance of all this is that while psychological and behavioral testing is very subjective, basic cognitive testing, as practiced in schools around the world, is very well understood, fair and easy to replicate.
With children who are verbal, can read a bit, write and do some very basic maths, a simple cognitive test, measuring these basic skills, assessing both  accuracy and speed would produce a pretty good surrogate index of cognitive functioning.  You could easily use such an index to measure the effectiveness of a drug in autism.  If large scale trials were done in Special Schools, this could work really well.  One week the class is on the placebo and the next week on the trial drug.  Then you could have trials with several hundred participants.

I think coming up with measurements for things like “social withdrawal”, as is currently done, is far too esoteric.  Let’s go back to the three Rs (reading, writing and arithmetic).

Nootropic drugs
I find it more than a coincidence that several of the autism drugs I am investigating, happen to be classed as nootropic.  Nootropic drugs are cognitive enhancers.

I have demonstrated that as you improve autism, you increase cognitive function; but perhaps as you improve cognitive function, you improve autism.  If this were true, it would open up new avenues for investigation.
There is an underground scene of cognitive enhancers, and if you probe the internet, you will readily find what works and what does not.

On the serious research front, here is a recent paper that is very comprehensive:-




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