Talk:Autism spectrum - Misplaced Pages

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This article has been mentioned by a media organization:

Marshall R. Childs (November 4, 2005). "Lessons from Asperger's syndrome". Daily Yomiuri.

New NHS report

New information to help support theory that measuring autism techniques have changed over time:

http://news.bbc.co.uk/2/hi/health/8268302.stm

"The NHS Information Centre found one in every hundred adults living in England has autism, which is identical to the rate in children.

If the vaccine was to blame, autism rates among children should be higher because the MMR has only been available since the early 1990s, the centre says" —Preceding unsigned comment added by 67.166.122.57 (talk) 07:47, 28 December 2009 (UTC)

Thanks, this looks like it would be worth adding to Epidemiology of autism and perhaps to MMR vaccine controversy. However, the actual NHS report doesn't seem to be available yet; at least I didn't find it easily available at the NHS web site. We can wait until it's actually published. Or if it is published somewhere now, can you please let us know where? Eubulides (talk) 09:19, 28 December 2009 (UTC)

This story is dated September. We discussed it then: Talk:Autism/Archive 9#Autism rate not increasing after all?. Colin° 11:13, 28 December 2009 (UTC)

Introductory sentence

"Autism is a disorder of neural development that is characterized by impaired social interaction and communication, and by restricted and repetitive behavior"

Your introductory sentence seems to privilege the atypical neural development in autism over other signs by beginning with "Autism is a disorder of neural development." It doesn't actually say "atypical neural development is the primary factor" or "the atypical behavioural development in autism is a product of atypical neural development," but by saying "autism is" this factor and it is "characterised by" these other factors, I believe it carries that implication. I believe this question is presently unanswered by the science: Is autism neurodevelopmental in origin or are the atypical brain structure and function a product of the disorder? Autism is equally a disorder of executive function characterised by atypical neural development and impaired affective contact and tolerance for change. Or, a disorder of affective contact, characterised by limited tolerance for change, impaired executive function and atypical neural development.

Is the first sentence implying what I think it is?
If so, should it? Anthony (talk) 09:24, 29 December 2009 (UTC)

Being a neurodevelopmental disorder is not a "factor" or a "sign"; it is a classification. For example, when the Common cold article says that the common cold is a "contagious, viral infectious disease of the upper respiratory system", this doesn't mean the upper respiratory system is a "factor" or a "sign" of the common cold: all that's being said is that the common cold is one of many diseases that are contagious and viral and affect the upper respiratory system. The wording is similar in Autism. It is standard practice in high-quality sources to define autism to be a neurodevelopmental disorder: for example, the introduction in Levy et al. 2009 (PMID 19819542) begins with "Autism is a neurodevelopmental disorder in the category of pervasive developmental disorders, and is characterised by severe and pervasive impairment in reciprocal socialisation, qualitative impairment in communication, and repetitive or unusual behaviour." Eubulides (talk) 09:44, 29 December 2009 (UTC)

Thank you Eubulides. How would you feel about changing the phrase from "a disorder of neural development" - 7 results on Google Scholar - to "neurodevelopmental disorder" - 6,840 results on Google Scholar? Can you tell me what classification system "neurodevelopmental disorder" is a part off? DSM IV? Anthony (talk) 13:07, 29 December 2009 (UTC) By the way, Neurodevelopmental disorder (which I visited before coming here) says it is an impairment of the growth and development of the brain or central nervous system, and lists a number of disorders that share this (sign?), but doesn't mention the term's role in taxonomy. Anthony (talk) 14:35, 29 December 2009 (UTC)

"A disorder of neural development" is easier to understand, and is less jargonish, than "neurodevelopmental disorder". Specialized jargon is appropriate for scholarly sources (which explains the Google Scholar results), but it is less appropriate for encyclopedia. The Misplaced Pages guideline for lead sections says that leads should avoid specialized terminology when possible, which is why it's worded the way it is. DSM-IV is about symptoms, not causes, and as such it doesn't talk about neurodevelopmental disorders. Eubulides (talk) 17:36, 29 December 2009 (UTC)

Thanks again. The present formulation is less scary. "Neurodevelopmental disorder" is the name of one of 5 "clusters" of mental disorders in DSM-V (I have just discovered). If what you are saying in the first sentence is "autism is one of that cluster of mental illnesses collectively known as the neurodevelopmental disorders", then it would be prudent to use the class name. If you are saying that disordered neural development is a feature of autism, along with impaired social interaction and communication, and restricted and repetitive behavior - that is, if you are referring to one of its features/signs then the sentence should read more like "Autism is a mental illness characterised by disordered neural development, impaired social interaction and communication, and restricted and repetitive behavior," not "privileging" one feature over the others. I realise I am being eccentric here. Everyone is taking it for granted that of course the etiology of autism will be located in the brain. I just think it's a little early for that. Anthony (talk) 19:54, 29 December 2009 (UTC)

I propose replacing the first sentence with

Autism is a psychiatric syndrome characterized by impairments in social interaction and communication, and restricted and repetitive behavior, all exhibited before a child is three years old. It is one of a cluster of conditions known collectively as the neurodevelopmental disorders.

Anthony (talk) 04:46, 31 January 2010 (UTC)

I don't see why that would be an improvement. It's much longer than what's there now. The phrase "psychiatric syndrome" gives the wrong connotation to typical readers, as it'll give them the incorrect impression of a child on a psychiatrist's couch. The idea that there's a "cluster of conditions" is not supported by reliable sources. Since reliable sources almost invariably call autism a neurodevelopmental disorder, not a psychiatric condition, why should this article do things any differently? Eubulides (talk) 04:51, 31 January 2010 (UTC)

Thanks Eubulides.

Length isn't an issue. Precision and clarity are.
It is a psychiatric syndrome. I don't accept a word of your opposition to calling it that.
It is one of that group known as the autism spectrum, which is a sub-group of that category called the PDDs, which belongs in the super-category called neurodevelopmental disorders... not the super-category called disorders of neural development. If you want to rename the category, run it by the APA first. Above, you say "a disorder of neural development" is easier to understand. I know what "neurodevelopmental disorder" means: it's a category in psychiatric taxonomy. What, precicely, do you mean by "a disorder of neural development"? That's not a rhetorical question. To me, it is laden with etiological implications. What meaning to you think those words to convey?
"Cluster" is used by the APA taxonomy taskforce I referred to above. I'm not wedded to it.

Anthony (talk) 07:35, 31 January 2010 (UTC)

"Length isn't an issue" Length is an issue. This is the lead; it's supposed to be a summary of the body, not an exposition at greater length. See WP:LEAD.
Yes, autism is a psychiatric syndrome; it is also lots of other things, including a pervasive developmental disorder, a psychological development disorder, a diagnosis, etc., etc. But the lead shouldn't be bloated by all the pigeonholes that autism can (accurately) be slotted into. It should convey concisely the most important thing that autism is, the same thing that our best and most reliable sources say. So, for example, Courchesne et al. 2007 (PMID 17964254) start off with the definition "Autism is a genetic disorder of neural development in which the first behavioral symptoms appear early in life." This is the kind of lead sentence that Autism should have. Recent reliable sources on autism avoid definitions like "Autism is a psychiatric syndrome", because such definitions would tend to mislead non-experts.
"Disorder of neural development" is a synonym for "neurodevelopmental disorder" that is easier for the typical reader to understand. The wikilink to Neurodevelopmental disorder should help make this clear to the expert, if it wasn't clear already. I'm not wedded to this synonym: if it confuses typical readers, we can reword it.

Eubulides (talk) 08:01, 31 January 2010 (UTC)

Length? What I tried to say was "accuracy should not be sacrificed for concision."
That article by the neurobiologist Courchesne is the only peer-reviewed article addressing autism to use disorder of neural development. Google Scholar finds 3,290 articles addressing autism that use its class name - neurodevelopmental disorder. I would like to see the class name used here and it made clear that it is a class name. Perhaps:

Autism is a (insert vague, politically acceptable term) characterized by impairments in social interaction and communication, and restricted and repetitive behavior, all exhibited before a child is three years old. It is one of those conditions collectively known as the neurodevelopmental disorders.

Anthony (talk) 09:01, 31 January 2010 (UTC)

By the way, where does this come from and what does it mean? "Recent reliable sources on autism avoid definitions like Autism is a psychiatric syndrome, because such definitions would tend to mislead non-experts." Anthony (talk) 09:08, 31 January 2010 (UTC)

It came from a comment that I wrote. In what sense is it not clear? The lead should not use vague terms. Eubulides (talk) 20:01, 31 January 2010 (UTC)

We agree. My worry is that readers will take "disorder of neural development" to mean "caused by retarded or aberrant brain development". We know that it means "neurodevelopmental in origin or to have neurodevelopmental consequences when they occur in infancy and childhood". I am concerned that "disorder of neural development" sounds so obviously like "disorder (caused by aberrant) neural development" that almost all readers will not follow the link to discover in the second paragraph of Neurodevelopmental disorder that the brain atrophy and hypertrophy, the under- and overactivity may be a a manifestation of the unknown primary cause; no more causal than the executive dysfunction or stereotypies. To share my concern here you need to assume the position that the odd brain is as causal as the odd social relations. Anthony (talk) 09:32, 1 February 2010 (UTC)

The typical reader won't distinguish between "neurodevelopmental disorder" and "disorder of neural development" in that sense; both equally connote "disorder (caused by aberrant) neural development". Furthermore, there's nothing wrong with that connotation, regardless of the wording; "Although the etiology remains undetermined, a general consensus has been that some type of aberrant neural development underlies the disorder of autism." (Rice et al. 2005, PMID 15791921). Eubulides (talk) 16:51, 1 February 2010 (UTC)

Do you have a credible review of academic and research opinion on the question of etiology? The lead and corresponding authors of the paper you cite are both brain imagers looking for autism's etiology in the brain. I can't access Bailey et al. 1996 but the other paper they cite in support of their assertion, Robert G. DeLong 1999 makes no mention at all of a consensus view, but is an interesting theory of neuropathological etiology. If neuroscientists agree abnormal brain development is the present best guess concerning etiology, then even universal consensus among neuroscientists is of low value and the assumption that cause lies in the brain must be guarded against. If there is consensus with a high degree of certainty across disciplines, then it has to be reported here with evidence.

But no matter what degree of consensus you find regarding best guess etiology, until the cause is actually found, it is reckless to call it a "disorder of neural development" or even "neurodevelopmental disorder" when you concede it will be misread by the typical reader as "disorder (caused by aberrant) neural development" while the actual meaning of the term is "caused by or causing abnormal brain development". In this article it should be called what it is: a "psychiatric syndrome" (despite your worries about the cuckoo's nest connotations), and if you use "neurodevelopmental" or its synonyms you must define it so as to avoid the erroneous meaning you say the typical reader will draw. Readers of peer-reviewed journals (should) know what this term means - "causing or caused by" - but you admit your readers will misconstrue it, and say it doesn't matter. Anthony (talk) 06:56, 2 February 2010 (UTC)

"Do you have a credible review of academic and research opinion on the question of etiology?" Sure, several are cited in Causes.
"If there is consensus with a high degree of certainty across disciplines, then it has to be reported here with evidence." There is, in Causes and Mechanism; this is summarized in the lead.
"it is reckless to call it a "disorder of neural development" or even "neurodevelopmental disorder" when you concede it will be misread" No, I did not concede that. Nor is it "reckless" to describe autism using the terms that reliable sources do.
"it should be called what it is: a 'psychiatric syndrome'" No, as discussed above, reliable sources typically do not define autism that way. And for good reason: ordinary readers are likely to misinterpret the word "psychiatric" in that context, even if the word is technically correct. Besides, the word "psychiatric" is unnecessarily broad. Let's stick with a mainstream definition rather than use an oddball one.

Eubulides (talk) 07:14, 2 February 2010 (UTC)

I think our point of contention is: I believe syndromes classed as neurodevelopmental disorders may be either the product of an obvious pathology or trauma, or a case of seemingly healthy brains behaving oddly (such as autism). You believe that if a syndrome is classified as a neurodevelopmental disorder, then the aberrant behaviour and affect is the product of the aberrant neural development.

I derive my belief from two things. I read Disorders considered to be neurodevelopmental in origin or to have neurodevelopmental consequences when they occur in infancy and childhood as saying that, and when you mentioned that it is a classification, I remembered having read many years ago that it was going to form a category in psychiatric nosology. My memory of what I read back then is that it would include childhood psychiatric syndromes associated with obvious brain disease, as well as those whose mechanism is not known but which are associated with abnormal brain function. I can't now find anything describing the inclusion criteria (but I haven't looked that hard yet). That is my reason for harrying you. If it is as I remember it and as I read Neurodevelopmental disorder, then, on its own, classification of autism as a neurodevelopmental disorder says nothing about whether the brain morphology "underlies" the disorder, it simply says "this syndrome includes unusual brain function and (hence?) morphology". And I am assuming some scholars, theorists and researchers are viewing autism in that way, too.

I could be dreaming about that paper I read, and misreading Neurodevelopmental disorder. If so, I apologise for wasting your valuable time and attention. I'll come back when I've read the ref's in Causes and Mechanism. But what I was hoping for was a study testing the assertion that "a general consensus has been that some type of aberrant neural development underlies the disorder of autism." That is, evidence of the asserted consensus. I'd be interested to know what percentage of what professions believe that, and how strongly. I didn't see anything like that in a cursory scan of the footnotes to those ref's. Anthony (talk) 10:47, 4 February 2010 (UTC)

The bottom line here is that Eubulides feels that he owns this article, and will not tolerate any tampering with it. It's not a well written article by any means, and tough and misleading reading for the laymen, but any changes will be rejected by him, just because it's his article and he will take his toys and go home. —Preceding unsigned comment added by 75.61.139.215 (talk) 05:36, 14 February 2010 (UTC)

Terminology and abbreviations

recent edit added a Terminology and Abbreviations section, describing about twenty abbreviations such as "AAC – Augmentative and Alternative Communication; communication through nonverbal means". This section is not helpful. The Autism article rightly doesn't discuss AAC, or the other ; the few places where it does use terms that have abbreviations, such as PDD-NOS, it explains them as it runs across them; that's enough. Anyway, it appears that the section was copied whole cloth from http://autismaspergerssyndrome.suite101.com/article.cfm/the_autism_dictionary, which we can't do (see Misplaced Pages:Copyright violations), so I reverted it. Eubulides (talk) 21:26, 29 December 2009 (UTC)

Salience

The article doesn't mention salience. It describes features which could be linked to salience but doesn't actually use the word. Is this because it's not a generally recognised term in this context, or is there some other reason? Nineteenthly (talk) 12:19, 30 December 2009 (UTC)

Salience is a generally recognized technical term among experts. Was there a particular wording change you'd like to propose? Please bear in mind that, other things being equal, it's better to use plain English. Eubulides (talk) 16:47, 30 December 2009 (UTC)

New statistics for autism in the US

I updated the statistics on autism in the US. The Center for Disease control has confirmed that 1 in 110 US children has autism. They also found that the rate of autism has increased 57% within four years. I wasn't sure how to add sources , so I'll list them here:

http://www.webmd.com/brain/autism/news/20091218/autism-jumps-57percent-in-just-4-years

First, that edit wasn't correct, as it confused the statistics for ASD (which is what the CDC report is about) with those for autism proper. Second, this is just one primary study, and although it's an important one, it probably doesn't need to be in Autism which cites multiple reliable secondary sources (reviews); see Misplaced Pages:Reliable sources (medicine-related articles) #Respect secondary sources. This new primary study is more appropriate for Epidemiology of autism #United States, where it is already cited. Eubulides (talk) 19:29, 21 January 2010 (UTC)

MMR

I assume most people have seen this? Wondering if it should be added somewere. http://www.guardian.co.uk/society/2010/jan/28/andrew-wakefield-mmr-vaccine Doc James (talk · contribs · email) 20:13, 3 February 2010 (UTC)

It's been added at MMR vaccine controversy and several related pages. It was also added to the lead here, but is way out of place, as this new report is merely a recent retraction of a primary study, and as per WP:PSTS we shouldn't be using primary studies (or retractions) when we have lots of reliable secondary sources on the same subject. Also, it's a pretty clear case of WP:RECENTISM. So I just now reverted the addition. Eubulides (talk) 03:31, 4 February 2010 (UTC)

Page loading efficiency and style

This page takes a long time to load, and part of this is due to the use of the standard Misplaced Pages citation templates such as {{cite journal}}. Recently developed faster & smaller Vancouver system templates such as {{vcite journal}} would make the page much faster to generate (roughly by a factor of two in my tests) as well as significantly smaller in terms of the HTML generated. Let's use them here; they're already in use in Heritability of autism, Epidemiology of autism, etc., and have resulted in major savings both for time and for the size of the generated HTML. Eubulides (talk) 08:28, 9 February 2010 (UTC)

MIND Institute research

Recent peer reviewed research at MIND Institute, UC Davis Medical School:

There is fairly recent research at UC Davis' MIND Institute, in the Autism Phenome Project, which indicates a particular pattern of maternal antibodies to fetal brain is found in a little over 10% of mothers of autistic children, and almost never in mothers of typically developing children.

As such, this antibody pattern is a very strong marker for autism and mothers of one autistic child need to be aware of it so, if they have the pattern, they can avoid becoming pregnant until the meaning of the pattern, and possible treatment, is known.

Disseminating this information could prevent a great many cases of autism and be a great boon to a lot of people.

After all the discussion about changing this article in the past, I am posting this here for discussion first.

The research paper is on PubMed and can be found by searching "Maternal antibodies" and "Autism". It is not a review article, as quoted below, Misplaced Pages rules allow peer reviewed papers as a source if properly identified as such and not given undue weight, and I suggest the finding be included in the article per those rules. —Preceding unsigned comment added by 75.61.139.215 (talk) 05:26, 14 February 2010 (UTC)

I expect that the previous comment is talking about the following, which is a review, not a primary study:

Enstrom AM, Van de Water JA, Ashwood P. Autoimmunity in autism. Curr Opin Investig Drugs. 2009;10(5):463–73. PMID 19431079.

However, this is published in a relatively obscure journal that I don't have easy access to. Eubulides (talk) 05:56, 14 February 2010 (UTC)

I should not have been so lazy as to post without getting the proper information here for discussion. The comment above refers to this study in particular, I am copying and pasting the entire abstract from www.pubmed.gov: Neurotoxicology. 2008 Mar;29(2):226-31. Epub 2007 Nov 6.

Autism: maternally derived antibodies specific for fetal brain proteins. Braunschweig D, Ashwood P, Krakowiak P, Hertz-Picciotto I, Hansen R, Croen LA, Pessah IN, Van de Water J.

Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, CA, USA.

I believe this research, which I am assured is being confirmed by the same researchers, should be included in this article. It could prevent a significant number of autism cases. Off the top of my head, something like : Relatively recent research has indicated that about 10% of autism cases are associated with a pattern of maternal antibodies to fetal brain not found in the mothers of typically developing children or children with developmental delays but not autistic. Researchers hope to develop a commercial test for this antibody pattern which will identify mothers at great risk of having an autistic child"

I am not sure if MIND should be mentioned by name, the test is not yet commercialized, but it's something the mothers of one autistic child really should be checked for. Even at only 10% of all autistics, and even considering that it would probably only be given to mothers of autistics, at least to start, it's still potentially a huge benefit, because it covers more people than most genetic causes that have been found.

By the way, I did not ask anyone at MIND about this, I am the father of a study participant, and my wife does not have the antibody pattern, but my reading indicates it's a big advance. —Preceding unsigned comment added by 75.61.141.31 (talk) 21:25, 16 February 2010 (UTC)

Thanks, here's a fuller cite to the study you mentioned, and I've taken the liberty of replacing the abstract in your comment (which unfortunately we can't reproduce here fully, due to copyright restrictions) with a pointer to the abstract:

Braunschweig D, Ashwood P, Krakowiak P, et al. Autism: maternally derived antibodies specific for fetal brain proteins. Neurotoxicology. 2008;29(2):226–31. doi:10.1016/j.neuro.2007.10.010. PMID 18078998.

Unfortunately, we typically can't cite primary studies like this directly, because there are lots and lots of them and as Misplaced Pages editors we aren't qualified to pick and choose. For example, how are we to know that we should cite Braunschweig et al. and not the following more-recent study, which seemingly is somewhat contradictory?

Morris CM, Zimmerman AW, Singer HS. Childhood serum anti-fetal brain antibodies do not predict autism. Pediatr Neurol. 2009;41(4):288–90. doi:10.1016/j.pediatrneurol.2009.04.014. PMID 19748049.

In order to puzzle this stuff out, we really need to cite reliable secondary sources (reviews of the research), and not primary sources (individual studies) directly, For more about this topic, please see Primary, secondary and tertiary sources and Respect secondary sources. In an area like autism, which is extremely well reviewed, we should be looking at the reviews. Enstrom et al. is one such review (and I expect that it reviews the primary study you mention) and I'll see if I can find others. Eubulides (talk) 21:56, 16 February 2010 (UTC)

Once again you are claiming the rules on primary sources are different than they actually are. In fact, primary sources, such as research papers from peer reviewed science journals, are NOT forbidden, despite the claims you make that they are. They are NOT.

In fact, the rules specifically give conditions under which they may be cited, and the proposed wording I've used for this change is permitted under those rules.

You don't own this article, and frankly I am upset that you continue to assert veto power over what other people put in when those edits are not forbidden and are good writing.

Please explain to me how this proposed change is not allowed.

Also, please explain exactly how the finding that CHILDHOOD antibodies do not correlate with autism refutes the claim that MATERNAL ANTIBODIES DURING PREGNANCY do.

I submit to you that it's you who are in conflict with the rules because you revert other people's edits on spurious grounds on a continual basis.

Also, I just followed the link you gave and reread the abstract, and they specifically do NOT question the findings from the people at MIND, read your own link before commenting on it, please. —Preceding unsigned comment added by 75.61.141.31 (talk) 01:53, 17 February 2010 (UTC)

It's not a matter of an actual contradiction, it's a matter of a seeming contradiction. And this was just one example: I'm sure that we could come up with dozens of primary studies about antibodies and autism. Why cite this one and not the others? Isn't that a WP:WEIGHT issue? And furthermore, your comment didn't address the points about respecting secondary sources. Why should this article be based on primary sources, which are lower quality, when better secondary sources are available? Eubulides (talk) 02:08, 17 February 2010 (UTC)

We shouldn't be citing primary studies, per WP:MEDRS and WP:RECENTISM. SandyGeorgia (Talk) 02:29, 17 February 2010 (UTC)

Remember when we did this before, and I proved to both of you that the links you give as justification for not using primary sources say no such thing? That in fact, by giving rules for using primary sources, they made it very clear such sources ARE allowed?

Both of you insist on misrepresenting the rules, it certainly can not be accidental. Normally I would not mind but this research, which seems to be borne out by time unless they are just plain lying about their findings, lead to a means by which mothers can avoid having autistic children, and it's simply too important that the information gets out to those who need it.

Basically, Eubulides feels he owns this article, and no one else gets to contribute, which is also of course in conflict with the rules.

So, your are both doubly wrong, and preventing potentially very helpful information from reaching the public, which, it's true, time may not bear out but that has also never been refuted in any peer reviewed journal articles I can find, and so meets the criteria for inclusion.

What's ironic to the point of being funny is that Eubulides states the article is simply too good to be messed up with what he regards as "bad" sources, when in fact it's a terrible article on many levels. —Preceding unsigned comment added by 75.61.141.31 (talk) 03:04, 17 February 2010 (UTC)

The article may be fine, I have not read it, but, SandyGeorgia is right, MEDRS and RECENTISM apply here. Oh, and if the autism article is so awful, propose changes here and get consensus. Dbrodbeck (talk) 03:26, 17 February 2010 (UTC)

I looked for other recent reviews of immune factors and autism and found this one, published in October–December 2009:

Stigler KA, Sweeten TL, Posey DJ, McDougle CJ. Autism and immune factors: a comprehensive review. Res Autism Spectr Disord. 2009;3(4):840–60. doi:10.1016/j.rasd.2009.01.007.

This review summarizes over 100 studies, including several from the MIND group (for example, Ashwood et al. 2008, PMID 18762342). Here's how Stigler et al.'s Discussion section begins:

"Results from studies of immune function in autism to date have largely been contradictory (Table 1). As reviewed, the investigation of subgroups of patients has yielded specific abnormalities, some of which have been replicated. What is the cause of these abnormalities? Are they secondary to the disease processes that cause autism and the resultant neurobiological dysfunction?"

This seems a reasonable summary of what is known about autism and the immune system overall. No doubt the Autism article can be improved further, but since we have recent reviews on this topic there's really no need to be citing primary sources. Eubulides (talk) 10:08, 17 February 2010 (UTC)

If the primary paper is contradicted by a secondary review, we should give weight to the secondary review. If this 10% group is a real, consistent difference, then the subtype of autism this represents should be extremely easy to identify. It'll take time to sort out of course, but a genuine, consistent difference should pop out rather quickly once identified. If the study is actually being confirmed by other researchers then we'll see a second paper in the future, and review articles. Which we can then cite. WLU (t) (c) Misplaced Pages's rules:/_complex 21:33, 17 February 2010 (UTC)

I am having trouble posting but will try:

1. No one has quoted me anything in the rules which says "no primary sources" That is because it does not exist.

2. Eubulides wants to keep control of the article, and so, using the rule that says primary sources are disfavored if a secondary source contradicts them, he bring a quote from a review article saying immune system findings have been contradictory. But E, the article seems to be referring to AUTISTICS, not MOTHERS OF AUTISTICS. It does not at all refute the paper I cited. So, it is not relevant to this discussion.

3. —Preceding unsigned comment added by 75.61.137.120 (talk) 06:51, 18 February 2010 (UTC)

3. In fact, as best I can find, there is nothing in the literature that contradicts anything in the paper from MIND. Eubulides has tried to cite two papers from other researchers which were both irrelevant because they are about the patients, not their mothers. Am I supposed to believe both his citations were honest mistakes? I do not. I think he wants to totally control this article, and he knows that he does not have the right to do that, so he comes up with spurious reasons for rejecting changes. He's trying, in very bad faith, to use the "contradicted by other researchers" rule for deleting primary sources, but it does not work, because the citations he gives do not say that. —Preceding unsigned comment added by 75.61.137.120 (talk) 06:59, 18 February 2010 (UTC)

4. I will respond to the comments about the research from MIND being either verified or refuted by other researchers:

First, if anyone else has done either thing, they seem to not have published. Although one would think that would take place eventually, the assumption that it would be done any time soon is not logical. These studies are expensive and require relatively large sample sizes. Even to do just a small study for replication of results requires dozens of autistics and dozens of controls, and to do specialized testing involving fetal brain. You can wait years for replication, but Misplaced Pages rules do not at all require that, they only require not giving undue weight to one study or to recent results just because they are recent. —Preceding unsigned comment added by 75.61.137.120 (talk) 07:07, 18 February 2010 (UTC)

5. Finally, I will tell you all why the article is truly terrible, since someone asked.

The article does not bring out the following points in a way which is comprehensible to a normal person:

1. Autism is a diagnosis, a condition, which can be caused by many different biological processes, and there is proven to be great heterogeneity in people diagnosed with autism. Just for example, it's very closely tied to Fragile X syndrome, but the vast majority of autistics do not have Fragile X. That by itself means there is more than one cause.

This point needs to be made in simple language, although technically the article does say there are many causes, it's so confounded with needless jargon that this is easily lost. Bad writing, really bad writing. —Preceding unsigned comment added by 75.61.137.120 (talk) 07:16, 18 February 2010 (UTC)

The point is, people are considered to be autistic when some cause or causes makes their behavior such that it fits the diagnostic criteria used by the medical profession to define autism.

Also, the fact that most autistics are mentally retarded should be emphasized more, and that autism is widely believed to be a brain condition ultimately. Certainly this is implied but again it's done poorly, when it should be the central and most clear part of the article. For example, the article says most autistics never live independently, without explaining this is due to retardation, so that a naive reader would be left wondering, "why, do they stack blocks all day and fail to feed themselves?" Again, very bad writing.

Genetics is also a part that should be rewritten. They keep looking for the causative genes but not finding them, and yet the article used Identical twin studies as proof of genetic cause. How about in utero effects? Should be balanced on that point.

Finally, it should be emphasized brain can malfunction countless ways, it's the most complex thing in universe and can screw up in the most complex ways. Very important point. —Preceding unsigned comment added by 75.61.137.120 (talk) 07:43, 18 February 2010 (UTC)

Please see #Brain can malfunction in countless ways below. Eubulides (talk) 08:27, 18 February 2010 (UTC)

Brain can malfunction in countless ways

"it should be emphasized brain can malfunction countless ways" Yes it can, but I'm not sure how this could be said in a way that could be directly supported by a reliable review on autism. Perhaps specific wording could be suggested?
"the article says most autistics never live independently, without explaining this is due to retardation" That's because the sources we found didn't say that it was due to retardation. If we can find good sources to support that claim, it should be added. However, for classic autism the fraction of individuals who also meet the criteria for mental retardation has been estimated at anywhere from 25% to 70%, and the fraction is much smaller for ASD in general, so we'll have to take great care in sourcing this claim.
"Autism is a diagnosis, a condition, which can be caused by many different biological processes, and there is proven to be great heterogeneity in people diagnosed with autism." This point is covered in Causes, which says "there is increasing suspicion that autism is instead a complex disorder whose core aspects have distinct causes that often co-occur." If this isn't clear enough, perhaps you could suggest better wording? We need something that's well supported by reliable sources, but you can look at the sources for the current claim, or find other reviews.
"How about in utero effects? Should be balanced on that point." The Causes section spends about 220 words on genetic causes, and about 180 words on in utero and other environmental causes. If anything, this is unbalanced in favor of environmental causes, since the consensus is that autism is mostly genetic (with heritability estimates like 0.7 and 0.9 being typical).
"Genetics is also a part that should be rewritten. They keep looking for the causative genes but not finding them, and yet the article used Identical twin studies as proof of genetic cause." No, the Autism article does not do that. It says "Studies of twins suggest that heritability is 0.7 for autism and 0.9 for the broader autism phenotype, and siblings of those with autism are about 25 times more likely to be autistic than the general population." There is no suggestion here that autism is always caused by genetics, nor that the evidence for genetic cause is due entirely to identical twin studies.
"the article seems to be referring to AUTISTICS, not MOTHERS OF AUTISTICS" No, Stigler et al. 2009 (doi:10.1016/j.rasd.2009.01.007) cites several studies on maternal immune factors, including Warren et al. 1990 (PMID 2273013), Croen et al. 2005 (PMID 15699309), Croen et al. 2008 (PMID 18554566), Singer et al. 2008 (PMID 18093664), and others (I got tired of writing them down).
'No one has quoted me anything in the rules which says "no primary sources"' We aren't saying primary sources should never be used. However, Misplaced Pages articles should be based on reliable, published secondary sources and primary sources should be avoided when these better secondary sources are available.
"there is nothing in the literature that contradicts anything in the paper from MIND" There is nothing in the literature that contradicts anything in hundreds of other primary studies on autism either. So why is Braunschweig et al. worth promoting, over and above all those other hundreds of primary studies? Particularly when we have good reviews in this area?
The most recently published high-quality review of autism in general that we know of is the review by Levy et al. (PMID 19819542), published in the November 2009 Lancet. It's quite a good and extensive review: 12 pages of small print. And it doesn't mention the immune-factor theories at all. In contrast, Autism is already devoting some space to these theories, supported by a reliable review, namely Stigler et al. 2009 (doi:10.1016/j.rasd.2009.01.007). Why should Autism devote even more space to immune-factor theories? Autism is already going out on a WP:WEIGHT limb to some extent, by devoting more space to it than Levy et al. and other reliable sources do.

Eubulides (talk) 08:27, 18 February 2010 (UTC)

Eubulides: All I can say is "there you go again" I looked at your links to support your claim, and for the third time, you've cited studies which are either not relevant, or do not refute the research on maternal antibodies which I wish to include in the article. The first most recent review article link does not have an abstract that tells me much and I do not have access to the full article, so I can not comment on what it says, but the others either are research on different subjects entirely, OR, in the case of the last citation, (Singer) they tend to support the general principle of maternal antibodies of molecular weight 36 and 39 kDa being tied to autism.

In other words, you repeatedly misrepresent the truth in order to find some reason to exclude valid material.

After three strikes, I say you are out and though I can't access the review article, since every other citation you've used to support your point did not do so, the odds are high that this one does not either.

I don't believe you are acting sincerely to make these repeated misrepresentations, you are just trying to find any excuse to keep out content you did not generate. That is the bottom line. —Preceding unsigned comment added by 75.61.137.120 (talk) 16:39, 18 February 2010 (UTC)

Please assume good faith, that is what we do around here. As noted, there are quite a few primary sources out there, and there is nothing currently that suggests what you want to add is better than all of those. We have a featured article here, a rather mature one at that. It is an article that relies secondary sources as WP:MEDRS suggests. Dbrodbeck (talk) 16:53, 18 February 2010 (UTC)

I am going to write up proposed changes for the other parts of the article. —Preceding unsigned comment added by 75.61.137.120 (talk) 16:49, 18 February 2010 (UTC)

Anon, I firmly agree with Dbrodbeck - your statements border on accusation, ascribe ownership issues where I can only see patient answers to your statements with referal to our policies, and fail to assume good faith. If you are going to put the effort into preparing draft changes, I would suggest getting an account and using a sub-page of your userspace. WLU (t) (c) Misplaced Pages's rules:/_complex 18:55, 18 February 2010 (UTC)

"you've cited studies which are either not relevant, or do not refute the research on maternal antibodies" The studies I cited were not intended to refute Braunschweig et al. 2008 (PMID 18078998): they were only intended to refute the comment that Stigler et al. 2009 (doi:10.1016/j.rasd.2009.01.007) "seems to be referring to AUTISTICS, not MOTHERS OF AUTISTICS". As Stigler et al. cites several primary studies about maternal immune factors, this comment was clearly mistaken. As WP:MEDRS#Respect secondary sources advises, Autism should not attempt to cite a primary study to dispute a review, and when in doubt it's better to omit mention of a primary study. Dbrodbeck's and WLU's suggestions are good ones. Eubulides (talk) 20:00, 18 February 2010 (UTC)

Review article new to PubMed.gov today: Curr Opin Neurol. 2010 Feb 12. The immune system's role in the biology of autism. WP:COPYVIO redacted - WLU Goines P, Van de Water J. PMID 20160651 —Preceding unsigned comment added by 75.61.137.120 (talk) 00:59, 19 February 2010 (UTC)

Please don't post lengthy quotes - it's a copyright violation and if it's just the abstract, particularly unnecessary if we have the PMID. Also note the concluding sentence includes the word may which means it's still not settled. Otherwise, as a recent review article it certainly seems like it could be included - though I'm not sure of the quality of the journal (for good or bad, I'm not familiar with the title or it's impact factor). WLU (t) (c) Misplaced Pages's rules:/_complex 01:24, 19 February 2010 (UTC)

OK, sorry for the lengthy quotes, but unlike the text of the actual article, I thought the entire abstract should be included because so much of it had relevance to the discussion here.

I don't want to get in some kind of huge squabble with people who are acting in good faith, but, you may not know the history, I was told that only secondary sources are allowed for Misplaced Pages articles, and this is simply not true.

Also, studies which did not refute the primary source seemed to be used as refutation, with the intention that this would mean the primary source could not be used.

In other words, I did not feel like I was being dealt with in good faith.

Good faith would have been first of all, making an ACCURATE statement of the rules, and conceding that primary sources are allowed as long as used correctly, ie, identified as primary sources, not refuted, not given undue weight compared to other sources, not given undue weight because they are recent.

None of these rules excluded the primary source I wanted to use.

I say again, none of these rules were applicable to the source as I proposed to use it, so the objection became "how do we know this primary source is better than any other"? which is NOT the standard for inclusion, and, since autism has so many different causes, really a denial of one of the main points the article should be making.

Put another way, all of the valid causes of autism should be included in the article. Those that are merely theoretical or are in serious dispute probably should not.

Those that are based on findings that have not been refuted and are not actually disputed should be included with caveats as to them being relatively preliminary findings.

This is science by the way, especially science of brain diseases that are not narrowly defined.

To be more specific, the fact that a secondary source, a review article, mentions related issues, but does NOT specifically refute a primary source, is not reason for exclusion under the rules, and, once again, if as many top line researchers believe, there are many different causes for autism, keeping information about any single cause out can not be justified on an intellectual basis. You are not removing chaff, or probable chaff, you are just taking out meaningful information. —Preceding unsigned comment added by 75.61.137.120 (talk) 03:52, 19 February 2010 (UTC)

Maybe I should try further to clear this up. Many, probably most, researchers in this field believe there is more than one, and possibly dozens, of causes for what is labeled autism per the diagnostic manual. If they are right, then findings of one primary source, such as "deletion on chromosome 9 causes autism" is NOT refuted, it's really important to emphasize this, is NOT REFUTED, by another paper that says, "copy number variation on chromosome 7 causes autism".

I've given an example of genetic causes, but of course it could have been "Maternal antibodies to fetal brain molecules of both 37 and 73 kDa, are almost always associated with autism" per the article I wanted to include, and that statement would not at all be refuted by mention of any other cause. It also would not be refuted by the publication of a review article which gave it short shrift, or for that matter did not mention it at all.

To make a crude analogy, suppose we were talking about causes of obesity. Someone says it's genetic, someone says it's environmental, someone says it's related to other disease processes, and all are right.

What Eubulides is doing is excluding say for example, the people who say, "Obesity is related to other disease processes" because their research is relatively recent, when in fact a huge percentage of all the research on autism is under 5 years old, and a lot is under 2.

He's not keeping it out because it's been refuted or even disputed, or any of the other valid reasons. That is what upsets me. In other words, rather than being a correct reason per the rules, it's an arbitrary over-extension of the general rule favoring secondary sources to an iron-clad prohibition of primary sources.

And the article, under his watchful eye, suffers greatly for it. —Preceding unsigned comment added by 75.61.137.120 (talk) 04:10, 19 February 2010 (UTC)

Primary sources should be used with great caution and shouldn't be used when there are secondary sources available - we also shouldn't use primary sources to 'debunk' or contradict secondary sources. Secondary sources take precedence because they are meant to synthesize and interpret primary sources into a coherent statement about some aspect of the topic they are talking about. our page on medical sources has been pointed to many times now, but I'll link to it once more - please read the whole page WP:MEDRS. It's not up to Eub or anyone to "make accurate statements about the rules" - it is up to you to review the policies and guidelines that have been cited/linked and determine if your suggestion still has merit within their scope and context. Misplaced Pages is a complicated place, and this is a featured article - so care should be taken in adjusting it. I haven't seen anything cited by Eub that causes me to raise an eyebrow, and I love the rules. It is up to you to try to learn and interpret them now. Given the complexity of autism and the huge amount of research that is focused on it, we can't include every new primary source, every new suggested finding, or even every new secondary source. Until there is substantial evidence that maternal antibodies has revolutionized the field or are now acknowledged as a primary driver of autism, it's inappropriate to give it a large amount of text because it is competing with a large amount of other information and speculation. However, if it's a true cause of autism, this will be determined and most scholars will begin to acknowledge it. The only thing that will bear this out is time while the results are replicated and extended outside of the MIND institute. So again, Eub's resistance to the inclusion of a primary source is appropriate per MEDRS, as well as general guidelines on primary sources, wikipedia not being a crystal ball, wikipedia not being a place to promote ideas and our efforts to avoid emphasizing new information just because it is new. The number of times a paper has been cited is a rough measure of its importance and (along with many other factors) helps inform how much emphasis we place on it. In these cases, the citation levels are zero simply because they are so new. So if this is a genuine finding, it will be replicated and extended and we can place more emphasis on it. If it revolutionizes the field, you will have the satisfaction of being right. But it may not, and we shouldn't be re-writing the article just yet. In the case of a lengthy article with a huge amount of publications on the topic, though primary sources are not necessarily prohibited, we should certainly be very cautious with them. I don't see Eub's approach as unwarranted or prejudicial, I see it as keeping an eye on the larger context and very justifiably expressing caution about a very recent publication. WLU (t) (c) Misplaced Pages's rules:/_complex 12:05, 19 February 2010 (UTC)

New paper by Ozonoff

This might be useful, if used cautiously - a prospective study of early signs of autism. WLU (t) (c) Misplaced Pages's rules:/_complex 21:27, 17 February 2010 (UTC)

Autism cites a review of this area, Rogers 2009 (PMID 19582867). Rogers works with Ozonoff and Rogers's review (which Autism summarizes) captures this primary study's main point that signs begin after the age of six months. We are also citing the review by Landa 2008 (PMID 18253102) which makes similar points. Eubulides (talk) 21:59, 17 February 2010 (UTC)

those with autism have low levels of oxytocin

They appear to have some beneficial response to nasal administered oxytocin in a new study. --68.35.3.66 (talk) 15:05, 18 February 2010 (UTC)

That's a press release and not suitable per WP:MEDRS. Even the original source article (though apparently published in PNAS, a high-quality source) would be problematic - new, unreplicated, very small sample size, preliminary and way too soon to represent a treatment modality. We're not a crystal ball and stuff like this should be treated with kid gloves until there's more evidence it's got a firm foothold in the academic community.

On a sidebar, I wonder how long it'll be before this one is picked up in the fringe community, a la mercury and testosterone chelation "therapy". WLU (t) (c) Misplaced Pages's rules:/_complex 18:51, 18 February 2010 (UTC)

This thread is about this recently-published primary study:

Andari E, Duhamel JR, Zalla T, Herbrecht E, Leboyer M, Sirigu A. Promoting social behavior with oxytocin in high-functioning autism spectrum disorders. Proc Natl Acad Sci USA. 2010. doi:10.1073/pnas.0910249107. PMID 20160081.

The fringe have long been talking about oxytocin, but they talk about everything, so that's not necessarily a minus. There is stronger scientific basis for oxytocin than for chelation (not that oxytocin is an accepted therapy or anything: it's still firmly experimental). It'd be better to cite a review, such as Bartz & Hollander 2008 (PMID 18655901), or Rossignol 2009 (PMID 19917212) (which gives oxytocin a grade B). Obviously these reviews don't cover this latest study, and that study might raise oxytocin's grade, but it's OK to wait for the next review (one will come along soon). Given the large number of experimental therapies (of which oxytocin is only one), Autism therapies is the best place to mention oxytocin; it already cites Bartz & Hollander on oxytocin and should also probably cite the newer Rossignol. Eubulides (talk) 20:00, 18 February 2010 (UTC)

Geographical Frequency

I think there should be some mention of the geographical frequency of autism in the epidemiology or some similar section. So far, most of the figures mentioned in the linked article on Epidemiology of Autism, focuses on the effects of the MMR vaccine, most of the figures from other countries are unknown or inconsistent. Maybe there is some research or a component to it that depends upon geographical or racial factors to the epidemiology, some countries have ~1% prevalence rates while some have far below even those. Since most of the research cited is from the US, at least a mention of some other (non-US) countries might be helpful with the context. --Theo10011 (talk) 01:48, 19 February 2010 (UTC)

We'd need sources to compare the geographic (really national comparison is what it sounds like you're aiming at) differences. I would guess those 'low' rates have more to do with diagnosis than environmental differences given the genetic prevalence, and it'll take reliable sources to sort it out. WLU (t) (c) Misplaced Pages's rules:/_complex 11:49, 19 February 2010 (UTC)

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