NPR’s Asperger’s FAIL

NPR’s “All Things Considered” ran a piece today on the difficulties in defining “mental disorders.” Based on what is posted on their site regarding the piece, they essentially report the opinion of one man, Allen Frances, who has taken it upon himself to do two selfish things. The first is that he blames himself for what he calls the “Asperger’s epidemic.” The second is that he felt compelled to discuss some unfounded–or at least, unsupported–assumptions about Asperger’s diagnoses on NPR.

Frances, former chief of psychiatry at Duke University Medical Center, was the editor of the previous edition of the “mental disorders” bible, the Diagnostic and Statistical Manual of Mental Disorders. We’re coming up on the fifth version of this hefty tome. From my personal experience, by the time it comes out, research will be about five years ahead of much of what it contains. But never mind that. Frances’ issue with IV was that it contained Asperger’s as a diagnostic category (he has other issues not addressed in the NPR piece). He describes having acquiesced in its inclusion based on needs expressed by professionals who were seeing children with autism-like behaviors that weren’t as severe as the disorder known as autism.

Now he regrets that. Why? Because so many children are now being diagnosed with Asperger’s. As the parent of a child with autism, as the friend of many families with parents or children with autism, as the acquaintance of many grown people with autism–including Asperger’s–I can say that many of us would perceive that increase as a good thing. Why? Because that means more people with autism are able to recognize what makes them tick, and it helps them to know that yes, in a world where many of us feel like Temple Grandin’s aptly described “anthropologist on Mars,” there are a lot of other like-minded anthropologists out there.

That’s not Frances’ take. Based on a study done at the time IV was formulated, Asperger’s was “vanishingly rare.” That’s not too shocking given that for most professionals, it didn’t exist yet. The explanation that he offers for the increase in Asperger’s cases isn’t that there is now a diagnostic category for it, but that people–parents, presumably–seek the diagnosis so that their children can get services at school. This part is worth quoting from the piece:

“And so kids who previously might have been considered on the boundary, eccentric, socially shy, but bright and doing well in school would mainstream [into] regular classes,” Frances says. “Now if they get the diagnosis of Asperger’s disorder, [they] get into a special program where they may get $50,000 a year worth of educational services.”

The clear inference to draw from this is that there are hundreds of medical professionals out there deliberately stretching the diagnostic checklist for Asperger’s to cover children who are “doing well in school” and who are “socially shy” (what other kind of shy is there?). I have a few problems with this scenario.

First, if your child is doing well in school, you don’t get services. Services are for academic support. Period. There aren’t “special programs.” A child may have academic supports from almost nothing to a full-time aide in an integrated classroom to exclusion in a resource classroom. There is no one “special program.” That’s one reason they call those things INDIVIDUAL education plans. Regardless, if you’re doing well academically, you don’t get these supports. If you have speech or motor deficits, you receive appropriate therapies. But the deficits have to be there–they’re not something you just make up.

Second, if your child is doing well in school, parents and schools and medical professionals don’t generally go looking for a label to slap on the child. Parents seek help because their child has a problem or problems. The gold standard for calling something a disorder is if it interferes regularly with the general processes of daily life. Doing well in school but being “shy” doesn’t meet that standard. With autism, with Asperger’s, we’re talking about debilitating, meltdown-inducing, terror-filling anxiety. There is a difference.

Third, I don’t have a clue where he got the monetary value from, and NPR provides no balance for that statement. It’s just sitting there, making any family with a child receiving any services look like a faking money suck. Nice.

The piece as presented on the NPR Website provides nothing in the way of confirmation from objective sources. No studies indicating overdiagnosis. No input from experts in autism confirming what Frances says. His off-the-cuff commentary, his self blame, his stirring the pot all just sit there, unchallenged. Even the apparent effort at “balance” at the end of the story is almost a non-sequitur, part of a story with no real core. It’s as though they can’t make up their minds about whether the piece is about difficulties of diagnosis in general, the blurred lines between disorder and merely discombobulated, or that Asperger’s in particular is an overdiagnosed condition.

They don’t even provide Frances’ qualifications to speak to autism in particular. Not all doctors are oncologists, and not all psychiatrists have a deep understanding of developmental disorders.

All in all, a shoddy presentation that is already making its way around the Twitterverse, with parents once again feeling as though they have to defend their child’s diagnosis of a developmental difference that often goes unseen. Here’s the deal: The diagnostic criteria are clear, and a child who’s merely eccentric and doing well in school does not fit those criteria. If there is some modicum of overdiagnosis, it’s certainly not because of parents overseeking a label so they can have their child be stigmatized at school by receiving services. Look to the diagnosticians to blame. Or, in the complete absence of any evidence from Frances himself or NPR, do what Frances asks and blame him. Given his focus on his regrets over IV, he clearly seems to have something to expiate. And so does NPR. I’ll turn to D.H. Lawrence and say that thing is…a pettiness.

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Yes, your instructor *has* heard it all

Really, we have

It’s Rosh Hashanah, and I thought it would be a good time to share one of the biggest busts I, as an instructor, have ever made of a student’s lying. You teach long enough, you really do get to hear it all, sometimes repeatedly from different students who truly think that they’re coming up with something novel as an excuse. Everyone’s got an extra grandmother lying around, waiting to give up the ghost on exam day. Everyone’s got a case of mono that magically strikes on test day or presentation day or big-report-due day. And many reckless students see fit to book flights home before the semester begins, invariably booking the flight during the already scheduled final exam period. And no, I cannot change your final exam time because you did that. Sorry.

But only once have I had a student manufacture a lie this bald, this daring. We were at a Catholic university, but the student was Jewish. In fact, the university has a relatively good-sized population of Jewish students, many of whom were always careful to let me know if a due date conflicted with their religious calendar, and we’d make mutually agreed upon adjustments. This particular student did not do so.

The Big Lie

Instead, after missing an exam a week or two after Rosh Hashanah–and really, you’d have to be living under a rock, gentile or not, to not know in that atmosphere that Rosh Hashanah had come and gone–he emailed me. His family, he explained, had bought him a surprise plane ticket home so that he could celebrate Rosh Hashanah with them, and not wishing to waste their money, he’d chosen to use the ticket rather than to be present for the exam. To go home to a city not too far away to celebrate Rosh Hashanah. A week or two after the holiday. He even described in some detail what fun they’d had together that weekend. He clearly assumed that as a non-Jewish instructor, I wouldn’t know Rosh Hashanah from Hanukkah and would believe this story.

Busted

But I do know a bit about it. So, I busted him, he ‘fessed up and received a zero for that exam grade. Frankly, from that time, I couldn’t view that student as anything other than a reckless storyteller who’d lie about his own religion and family in a cynical belief that someone who was not a member of his faith would be utterly clueless about it and believe his lie. Not the best way to impress an instructor, that.

While grandmas (for some reason, it’s never grandpas although it is occasionally a beloved aunt), mono, stomach bugs, and the sporadic dead-honest “I slept through it” top the excuse list for frequency, that bold, easily checked gambit from this student tops my list of dumbest excuse attempt ever. Never try to use a major religious holiday that can be easily checked with the click of a mouse as your reason for missing a test. My advice? Stick with mono, and try to look really, really tired.

Starting college biology this fall? Here are some tips

As someone who’s taught thousands of students, I have a few tips for those of you kicking off the semester. While my focus has always been biology, these pretty much apply to almost any course.

1. Go to class. It’s the number-one thing you can do to do well. Don’t sleep in. Don’t skip just because you got to talking with someone in the coffee shop who’s pretty hot and you’d rather sit there making progress than make progress just at that moment in class. Go. To. Class. Trust me.

2. Take notes in class. Good, thorough notes. If your professor allows it and you learn best through listening, record the class. Always ask permission first.

3. Ask questions in class. How your instructor receives questions may determine how nutty you can get with this. I always welcome questions because my experience tells me that if one student doesn’t understand something, about 12 more who aren’t speaking up don’t get it, either. Consider yourself their spokesperson, raise your hand, and ask.

4. Do readings before class. Even if you don’t understand half of what you read, at least vocabulary won’t be a total shock to you. If you do understand it, then lecture should serve as good reinforcement. Also, I think too many students overlook figures and graphs in reading material. Make sure to review and understand them, as graphic representations in biology are often the most relevant ways to learn the material.

5. Understand your working vs. long-term memory. You must transfer from one memory bank to another. The best reinforcement you can do is to review your notes/reading as soon after lecture as possible. Get that information in there through this second review, whether it’s by re-reading, a study group/partner, or listening to your recorded lecture again.

6. Don’t start studying for an exam the day before the exam. Start studying for the exam whenever you get new material. That means after every class. This isn’t high school. Much of this information is complex and requires time for absorption and real understanding. You’ll do yourself a huge favor if you study every day after class as though you had quiz over new information the very next day.

7. If your instructor indicates being amenable, take advantage of emailing/message boards/other interfaces to ask questions for clarification as you study. My best students often were those who emailed me questions as they went along. These students were not, however, the ones who tried to blanket me with my own review questions the night before a big exam, hoping I’d answer them.

8. Use office hours, especially to clarify last-minute questions or complex information. If your instructor is not a fan of electronic communication, use the office hours.

9. Think like your instructor. What have they emphasized in class? Are there copies of old exams (legally acquired) that might give you an idea of how they ask questions or what depth they’re expecting for answers? If you were writing a test over this material, what would you ask? Ask it, and then answer it.

10. Go to class. Have I mentioned this one yet?

Next up: How to study for biology.

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