Reading the Research: Systemic Reform in Mental Healthcare

Welcome back to Reading the Research, where I trawl the Internet to find noteworthy research on autism and related subjects, then discuss it in brief with bits from my own life, research, and observations.

Today's article describes a path to improving existing mental healthcare.  Many autistic people suffer various forms of mental illness.  I personally have an anxiety disorder and a type of long-lasting, low grade depression called dysthymia.  

Longtime readers will recall I have various gripes with the US healthcare system and its accessibility.  But even when someone has insurance that covers mental healthcare, this paper points out quite clearly that the outcome is not always good.  

The summary has an example of a person being prescribed a particular pill and the fallout when the office failed to follow up with the person.  But as we found out a couple weeks back, this is pretty normal, especially when it comes to children.  

As a reminder, the best and most effective response to "I seem to be suffering from mental illness" is "Okay, let's get you booked with a therapist."  The typical response from the system seems to be, "Okay, here's some niche pills that might or might not help you." This study tells us that even if someone is prescribed appropriate medication, the chances of them receiving proper follow up care are minimal at best.  

Considering how frustratingly uncertain the results of pharmacological interventions (ie: pills) are, it's simultaneously terrifying and infuriating to know this is how things are.  Terrifying because the side effects of anti-depressants are many, varied, and sometimes crippling, and infuriating because of how systemic this utter failure is.  It's not just scattered bad doctors' offices that doesn't care about their patients.  It's basically every doctor's office, unless they are spectacularly on top of things.  

There's a great deal of need for jobs during (and after) this pandemic, and a great deal of hand-wringing about how to provide those jobs.  There are various ways to create those jobs, but in all honesty, some of them are more valuable than others.  There is a clear and pressing need, nationwide (if not worldwide) for better healthcare and outcomes.  So why not hire people to follow this research-proposed framework?  

Particularly, why not hire autistic people and other people with disabilities?  This kind of work can be done from home.  You'd need database access and a work phone.  And the ability to ask scripted questions and listen to the answers, perhaps even ask some followup questions.  In short, this is not complicated work, and yet it would be highly valuable.  Why not?  We'd all be better for it.  

(Pst! If you like seeing the latest autism-relevant research, visit my Twitter, which has links and brief comments on studies that were interesting, but didn't get a whole Reading the Research article about them.)

Book Review: Dietary Interventions in Autism Spectrum Disorders

Dietary Interventions in Autism Spectrum Disorders: Why They Work When They Work, Why They Don't When They Don't, by Kenneth J. Aitken, provides a discussion of the history of special diets for symptom management in autistic people.  Despite the rather blunt title, the book seems to be aimed at healthcare professionals.  However, a layperson such as myself can follow the gist of the matter without understanding the specific formulas and chemical interactions described.  

I'll preface this review by informing you, sadly, that there is no one proposed diet that solves all autistic ills.  This won't surprise you if you're familiar with the saying, "If you've met one person with autism, you've met one person with autism."  

Also, when the word "diet" is used in this book, it is not referring to the typical USian understanding of the word, which refers to the fad weight loss diets that come and go like the wind.  These diets are undertaken to lose weight, and, without assuming that goal is even accomplished, dropped quickly.  The book does not, in fact, give any care for weight loss at all.  Apparently a significant portion of the autistic population is rail thin instead of obese.  That sounds nice to me, but the author insists this is as much as problem as obesity.  

At any rate, the book's intention with the word "diet" hearkens back to an older understanding of the word: the food and drink regularly consumed.  In short, these diets are meant to be undertaken in the long term.  They are lifestyle changes, not temporary measures to appease one's guilt or prop up one's body image.  (I have a deep dislike of "dieting," can you tell?)

The first section of the book discusses ASD and special diets.  It contains good background knowledge, some of which is helpful to understanding the how and why of the diets.  It also covers how food and nutrition has shifted in the development of humanity and technology, which I thought was quite interesting and helpful.  To cap it off, it contains information about particular toxins whose effects are particularly obvious in autistic people, as well as protective factors against these toxins.  

The second section is the meat of the title:  Nine diets are analyzed and summarized in brief (sometimes "less than 10 pages" brief).  Factors considered in each analysis include the evidence for and against each diet, possible health problems associated with the diet, and practical difficulties with following the diet.  

I was particularly impressed with the author's choice to have that last criteria in each section.  It strongly suggests he's aware of the challenges that come with making these changes.  The specific sections, too, suggest his awareness of the differing situational challenges any given family might come up against.  Not every family is going to be able to find farro to cook with, for example.  

Each analysis also includes a Resources section, which tends to include a healthy mix of books, websites, organizations, and scientific research.  This is in additon to the Resources section at the end, which contains all the same info but centralized.  The information in this book is about ten years old, so it's quite possible that some resources may not work.  However, the author has listed enough of them that at least one should serve to get you further information and likely other resources.  

Part three of the book is the author's answer to "but which of these diets should I do!?"  He proposes a 10th diet (the Simple Restriction Diet), drawing on the best parts of the most effective diets previously described.  He includes a proposed plan, complete with worksheets, a table to help you match problem foods with toxins, and a suggested timetable with which to implement the diet and subsequent re-introductions of food categories.  

In all honesty, I kind of want to try this Simple Restriction Diet.  It seems distinctly promising in terms of both weight loss and narrowing down whatever keeps wrecking my guts.  Maybe even whatever's wrecking my spouse's guts.  In practicality, I'm... dubious of my ability to convince my spouse to try this diet.  "Restriction" is a very apt descriptor, because this diet has you eliminate or heftily reduce quite a bit of commonly consumed foods.  Feasibility is a serious concern.  

The suggested timeline for implementing the diet is actually only three weeks, after which you start adding in carbohydrates to a point, and watching for adverse reactions.  And then, assuming none, you move onto transitioning off the next category, and so on.  If adding a category back in causes a reaction, then you can take that to your doctor and get more specific tests.  

As such, it's still a significant expenditure of time and energy... but you aren't necessarily bound to a particular diet for life.  The author even stresses testing your final resulting diet every once in a while, because none of these are perfectly scientifically sound.  Improvements might be seen  while on a gluten-free/casein-free diet, but not actually be related to the diet itself, and the person may find some years hence that they don't need to adhere to it but still remain healthy.

I have a couple complaints.  The first is that no mention is made of the difficulties of transitioning off a typical USian diet.  Sugar addiction is a very real and very miserable thing to detox off of.  I have done so several times and will need to do so again at some point soon, because Halloween candy and Christmas sweets exist and I only have so much patience with not eating them.

The second is that I don't feel there are sufficient resources for the author's pet diet, the Simple Restriction Diet.  There are resources in plenty for the other nine he looks into, and one could, I suppose, research the relevant ones and try to combine them with a great deal of effort.  I would much rather have links to directly relevant cookbooks, with no guesswork about whether I'm failing at this or that aspect.  

All in all, I was impressed with this book.  It's analytical and healthily skeptical while remaining positive and hopeful.  It acknowledges the shortcomings of the science without disallowing their effectiveness.  It explains the science in detail without being overly verbose, and you needn't truly understand the chemical formulas to follow the rest of the discussion.

Read This Book If

You're an interested care provider, interested parent, or interested autistic.  This is a pretty focused book.  It's written well, in a manner that seems aimed at healthcare providers but is accessible to laypeople (except maybe the chemical formulas).  It discusses the science (or what exists of the science) as well as providing feasibility information and potential positives and negatives to each diet.  In short, this is a good resource for anyone looking into special diets, and I'm glad my local library has it in their collection.  

Reading the Research: Parental Therapists

Welcome back to Reading the Research, where I trawl the Internet to find noteworthy research on autism and related subjects, then discuss it in brief with bits from my own life, research, and observations.

Today's article describes a trend I'm seeing more and more, especially during this pandemic: the tendency to turn parents into work-from-home therapists.

The need for services and therapists, I think we can all agree, is greater than the supply and availability.  

This is in part due to the ever-expanding numbers of people diagnosed with autism, but also includes geographical differences.  Rural areas, for example, are less likely to have a selection of speech and language pathologists with training to aid them in supporting an autistic youngster.  And of course, one must never forget the cost of these services.  This too serves as a barrier that keeps people from the supports they need.  

So all these barriers exist, but the need hardly disappears simply because the supply isn't there.  What then?  

Increasingly often, in this "gig economy" we now find ourselves in... the answer is "fine, we parents will do it ourselves."  

At first glance, this sounds great.  There are training programs and apps and books that will attempt to teach you the philosophy and the actual mechanics of various types of therapy.  Then you don't have to shell out hundreds or thousands of dollars for that therapy, never mind transportation costs and the risk of viral infection.  

However, there's a few problems here.

First, adding the "therapist" hat to a parent puts an enormous amount of stress on that person.  Parents of autistic people tend to be pretty well stressed already due to our higher support needs.  So then, not only do these parents need to absorb an immense amount of knowledge, they also have to put it into practice and then go right back to parenting afterwards. Because the stress level is so high, more mistakes will be made, and the quality of the therapy will suffer.  Also, overstressed parents also don't do as good of a job parenting, because nobody performs their best when they're exhausted all the time.  

Second, the quality of these DIY resources varies widely.  While the insurance companies push Applied Behavioral Analysis as the One True Autism Therapy and many resources are available to teach those techniques, most autistic adults are firmly against it.  I was reasonably well-impressed with Floortime as a therapy, but practitioners are few and far between, never mind DIY resources.  

Finally, there's the cost in terms of time.  The time requirements for therapy are anything from an hour or two a day or "40 hours a week, so forget cooking, cleaning, and time for yourself."  This is simply not possible for some parents, who already work a job or three simply to keep a roof and food in existence.  In some cases parents will band together and trade off duties so the others can have a moment to take care of their other children, or even, God forbid, have some well-deserved time to themselves.  This is difficult to set up at best, and practically impossible during the coronavirus pandemic.  

Is the whole idea of parental therapists utterly without value?  I don't think so, no. But I don't see it as an equal value alternative to professional therapists and services, regardless of how effective the training materials are.  

(Pst! If you like seeing the latest autism-relevant research, visit my Twitter, which has links and brief comments on studies that were interesting, but didn't get a whole Reading the Research article about them.)

Grocery Shopping on a Special Diet: Pop and Booze

Welcome back to my autism-aware shopping trip through the grocery store.  Week by week, I'm showing you what the store sells, prune down the selection to what's safe for me (because autistic people can have very sensitive systems) and point out various gotchas the store tries to make you buy stuff you didn't come for. 

As a reminder, I shop with the following conditions in mind:

• dairy-free
• low sugar
• avoid ultraprocessed junk
• avoid food coloring
• conditional vegetarianism
• avoid high histamine foods
• awareness of gluten-free options and sugar-free options

Last week we found the juice aisle was full of sugar water and lies.  This week we'll explore the more honest but definitely still sugar water variety: pop.  Or soda, or Coke, depending on where you hail from.  The exact terminology is a whole debate, but because I live in the Midwest, it'll be pop in this post.  

I'll just state this once.  Sugar water is bad for autistic people.  It's bad for humans in general, but the artificial colors and sweeteners found in pop are particularly detrimental to people with shaky biologies.  When nutrition doctors talk about quick-and-dirty measures to improve your health, they'll often start with having you stop drinking pop.  The stuff is literally that irredeemable.  

As you can see from just the cursory picture of the aisle here, the US has a love affair with carbonated, flavored sugar water.  

Remember how we couldn't get away from snacks in previous aisles? Yeah, there's no escape here either.  I'm not even talking 8 ounce aluminum cans.  Coke has apparently decided that portioning is Serious Business, so they're selling 2.3 ounce containers.  "Sip-sized."  I guess that's a positive development?  It's all going to be unhealthy but if you can handle just having a tiny serving, that's an improvement.  

...This is the US, though, so I have doubts it'll catch on.  Coke tries many things to keep at the top of the food chain in the sugar-water department.  This will likely join the many failures that policy accrues.  Coke itself, though, will likely stay at the top, because it tries these things and uses what works.  

Please note, too, that this entire picture is Coke products.  Mostly Coke itself, in at least five different packages: 2 liter bottles, 8 ounce aluminum cans, 12ish ounce plastic bottles, those 2.3 ounce "sip" size things, and glass bottles somewhere between the cans and the plastic bottles.  When I say people in the US are spoiled for choices, this is one of a dozen things I can easily point to.  

Dr. Pepper is another large drink corporation.  I have no particular fondness for any pop at this point.  I used to drink it occasionally when I was younger, but I always hated the carbonation.  The way it made my mouth feel was upsetting.  

Past the Dr. Pepper is the "not a major brand" brands of pop.  Mostly dominated by Zevia. We'll come back to that brand later.  You can also find various "craft" cream sodas and root beers here.  My spouse and I spent a decent amount of time looking for a cream soda we liked, and ended up only finding one of the 6-7 options.  Cream soda is maybe the only pop I'll bother with at this point, and even then, I mostly just steal sips from him.  

Coffee drinks?!  What are you doing in here?  I guess because of what comes right after it: the energy drinks.  For people that are either too young or too callous of their own health to care about what these do to you.  I think I've consumed a couple energy drinks in my life, and regretted it each time.  They're everything that's wrong with pop, plus shaking your system while screaming, "WAKE UP WAKE UP WAKE UP!"

Various iterations of lemon-lime and other non-cola pop.  

And of course, Coca Cola's biggest competitor, Pepsi.  

So apparently there are more gaps between aisles than I thought, they just happen in aisles I don't frequent.  Here we see the gap between the pop aisle and the booze section.  Likely because mixed drinks are a thing.    

Faygo is a Detroit-based company, fyi.  It's a little surprising to me that they're this far down the aisle.  On doing my homework, they're owned by Dr. Pepper, though, which is definitely a far third in the race for #1 pop company.  

And then there's more water.  Sometimes the sectioning in this store makes perfect sense to me, and sometimes it just makes me scratch my head.  Anyway, we have more environmentally-irresponsible plastic bottles here, followed by gallon jugs of three kinds of water: distilled, "spring," and "purified."  I'm told distilled water tastes horrible, and I have no idea why.  Spring water often isn't actually from a spring, and purified water is definitely purified but to what extent and how is typically unknown.  

I have a couple gallons of the last type in the basement just in case of emergency.  It wasn't too expensive, and it only takes three days to die of water deprivation.  

On the other side we have even more environmentally-unfriendly bottled water.  Remember from last time that the PH of bottled water varies markedly, too.  Do your homework.  

Before we ditch this aisle of poisonous sugar water, let's look at some calorie counts.  12 ounce serving nets you 150 calories and a whopping 41 grams of sugar from high fructose corn syrup.  Yikes.  

Coke is only marginally better, at 140 calories and 39 grams of sugar.  I'd almost bet that's on purpose, actually...  

What about the zero sugar option?  Seems fine nutritionally, but what's the sweetener?  Aspartame.  Nope.  Big nope.  Remember, monk fruit, sugar alcohols like erythritol, and stevia are your best non-sugar options.  Artificial sweeteners like sucralose and aspartame are bad news for sensitive guts like mine.  

Aspartame...

And stopping back here, to look at the only semi-redeemable thing in the entire aisle.  Zevia is so named because it's sweetened with stevia leaf extract.  It is also not colored, which makes it even safer to drink.  I still don't like the carbonation.  

If you decide to try Zevia, please keep in mind that different sweeteners have different tastes and aftertastes.  Just like swapping to diet pop, it tastes slightly different and also has a different aftertaste.  On the bright side, this stuff won't rot your teeth.  Also there's 12 different flavors, so you won't run out of variety anytime soon.

Here's the catch, though.  It also will not feed your sugar addiction.  Yes, addiction.  Remember how sugar bombs are everywhere in this store, even in supposedly healthy things like granola bars and yogurt?  Sugar, like drugs, is an addictive substance, and you can become used to and dependant on consuming high amounts of it.

This isn't really noticable in a normal US life, because as I've shown us, the grocery store is very happy to feed you piles of sugar.  However, when you do something like swap to sugar-free things, you may find yourself having sugar cravings and withdrawal symptoms. 

Personally?  I became confused as I drank these sweet beverages but didn't feel satisfied by doing so.  That's the sugar addiction not being met.  

Okay? Moving on, then.  To the only-slightly-more-honest of drugs: alcohol!

I am not much of an alcohol afficianado, so this is going to be a relatively quick tour.  The alcohol section actually comprises three aisles, not one.  As you can see, it's not arranged in an aisle fashion so much as an interconnected series of themed sections.  There is still order to the chaos, though, as we'll see.

While it's a state- and society-approved drug, never forget that alcohol is a drug, and you're effectively poisoning your brain when you consume it.  It can have interesting effects on autistic people, even making us feel almost "normal" after a certain amount.  But of course, the first thing alcohol affects is your judgement.  I've read stories of autistic people adopting the bar-hopping way of life because that was the only way they could experience human connection.  Suffice it to say these stories typically did not end well.

This first and largest area is devoted to wine.  All kinds of wine.  Including, as you can see, refrigerated options for people that didn't have time to plan ahead.  I didn't realize canned wine was a thing, but here it is in many varieties.  Bottle or can form, chilled for your convenience.  These are all sugar bombs, even the typical bottles of wine, by the way.  Wine is fermented with sugar, and then often sweetened with more sugar to be palatable.  

Single-serve bottles and juice-box style containers.  Dear me.  Continuing down the aisle finds us the sparkling stuff.  As I mentioned before, I'm not fond of carbonation.  It's okay if it's relatively gentle, but pop typically isn't, and neither are some of these options here.  

Just to the left of all this are specific sections for each type of wine.  This was the Cabernet Sauvignon section. My father could probably rattle off what each type of wine is like, but apparently in lieu of a guide, the store decor itself will try to help you.  

The Merlot, Zinfandel, and Malbec sections.  There were several more aisles just like this, but you get the idea.  Note the "10% off any 4 wine bottles" deal.  A boon to alcoholics everywhere.  

Was 10% off not enough?  Here's the really inexpensive bottles, and some free advice for serving sizes.  

Quantity in a glass bottle insufficient for drinking yourself under a table?  Here's the big box wines.  Presumably the quality isn't great, but for that price, it's never been so economical to be a socially-appropriate alcoholic.  

I may have an opinion about all this, can you tell?  

After we pass the wine, we get the only alcohol I gave two figs for when I was 21: the hard stuff.  Rum, vodka, tequila, gin, and cognac, among others.  When I turned 21 I decided I was going to find out my tolerance to alcohol, its effects on me, and how wary I should be of it.  I skipped right past wine because no alcohol tastes good to me, so why bother with the gentle stuff when I could just drink something significantly more effective in smaller quantities? 

I learned a few things.  First, that I could increase my tolerance and ability to recognize how inebriated I was with practice.  Second, that my personality doesn't particularly change when I'm drunk, I simply have reduced judgement and capabilities.  And third, that hangovers are as godawful as they're written about in books (and 100% optional if you're smart about things).

After I answered those questions for myself, I stopped drinking as much, and then at all save in social company or on rare occasions.  At this point, I think I have a sugary alcoholic beverage maybe once every 2-3 months.  My tolerance has reduced itself accordingly, and it now takes very little alcohol now to make me tipsy.  

I also have the uncanny ability to recognize when something is alcoholic, right down to tasting a teensy amount of it in a dessert I had at a restaurant once.  That was only relevant because one of the other diners was avoiding alcohol like the plague, so she had to set aside her dessert because of it.  Alcohol and some other drugs give me the sensation that something is burning, painlessly, in my stomach.  It's kind of a useless superpower, but it's mine.  

If you looked carefully in the hard liquor picture, you could spot this display tablet.  It has moving pictures and makes sounds.  You can use it to look up recipes...

Including ones significantly harder to puzzle out than this one, natch.  

You could also use it to look up specific boozes and get... well, someone's opinion on how they taste, I guess.  Taste buds and experiences vary quite a bit, actually.  What you taste when you drink something, and what a professional wine taster (or rum taster, I guess) tastes, are likely to be very very different.

I presume these screens serve two purposes.  First, they're advertising.  I didn't watch them for very long, but they were peppered throughout the section to tell you about specific brands and do cool animations that make alcohol look enticing.  

Second, they save the store a great deal of staffing cost by simply automating the answers to, "how do I make cocktail X?" "What does alcohol Y taste like?" and "What booze should I buy?"

Just like there were sections for wine, there were also sections for whiskey based on geographic location.  This was the US section, but there was also a section for Ireland and several other countries that I guess specialize in making it.  Presumably whiskey is the alcohol of choice for toxic masculinity in this area, or something.  I can't imagine why it would have so much shelf space otherwise.

Yeah, you knew we'd get there eventually.  Now entering the Other Sugar Bombs and beer section.  

Hard ciders and sodas are sugar bombs with booze.  Of all the booze in the store, I pretty much only drink hard cider at this point.  I found one particular European important brand with some neat flavor combinations, bought of a ton of it, and proceded to not give a crap ever since. 

The big brands of beer, I guess?  I'm not going to lie, I barely know any of these.  

Craft beer has caught on in much of the US in the last 5 years or so. I don't entirely hate the trend since it can spark interest in supporting local brands.  However, in some cases people literally just pour brand name beer into fancy cans, seal them up, then charge a premium for it.  

Craft brewing is especially popular here in my city.  At least one of the brands in this picture can quite literally be found downtown.  I've literally had a drink and food at the pub off their brewery.  

A little bit of extra horror for the recovering alcoholic: more adult juice boxes.  I've seen these positioned everywhere in the store, from the impulse buys on the way in, to sitting in the middle of the fruits and vegetables, mocking your desire to leave without buying anything unhealthy.  

As a final note, these two sections, the pop and the booze, sit next to the snacks sections, which are themselves behind the various cooking staples.  The other side, which we'll get to next time, is the frozen foods.  So basically a complete shopping trip will always have you going past the ultra-processed snacks, sugar waters, and double-poisons sections.  

I always assumed there was a method behind my grocery store's organization, but only now am I seeing how truly manipulative and abusive it is.  And you get to see it with me.  Sorry/You're welcome.  

Reading the Research: The Limitations of Brain Scans

Welcome back to Reading the Research, where I trawl the Internet to find noteworthy research on autism and related subjects, then discuss it in brief with bits from my own life, research, and observations.

Today's article is interesting, but badly in need of a reality check.  

So, first thing.  What is a brain scan?  I'm going to grossly simplify, because I presume you value your time and don't want to read a detailed breakdown of the difference between a PET, MRI, and fMRI scan.  

A brain scan is like an x-ray, but specifically for your brain.  Like an x-ray, it's a snapshot, more or less a picture at a point in time.  Where an x-ray shows your bones (and organs, if you know where to look)...

 a brain scan shows brain activity.  

A trained x-ray technician can look at the x-ray and see cracks in your ribs that explain why you've been having chest pain, or a bulge in one of your spinal disks that explains your lower back pain.  

A trained fMRI technician can look at your brain scans, compare them to what little we know about "normal brain function" and note abnormalities.  

You might notice I've used specific examples for x-rays, and air quotes and more dubious language for fMRIs.  That is very much on purpose.  The fMRI technique was invented in 1990, which you'll note was about 30 years ago.  The discovery of x-rays was in 1895.  In the grand scheme of technology, fMRI is a baby.  

A very promising baby, likely with a bright future ahead of it, mind.  But a baby all the same.  What it might become is unknown, and much of what it can do is theorized and speculated upon.  

What does this have to do with the article?  Well, here's the thing.  The researchers have tossed a thousand or so autistic brain scans at a computer (actually 14 different analysis models, but it's simpler to say "a computer"), and hope to have the computer not only be able to tell which brains are autistic, but explain how it came to that conclusion and present personalized prognoses.  That's actually a pretty small sample size for something like this, but it was the convenience sample- the database of these scans is open source and free for research purposes.

This is very much akin to taking that baby, handing them roller skates, and having full expectations of brilliant dance skating.  

That's not to say that brain scans can't be exceedingly helpful to psychiatry and even autism treatments in specific.  One of the problems is that autism itself isn't well-defined, and as such, any program looking for it is going to be subject to that ambiguity.  The study itself even acknowledge that the Related Work section.  We know there are some parts of the brain that are associated with autism, but there are many of them.  And with no subtypes of autism, saying "this part affected this way means the person will have an increased chance for depression" is just guesswork.

Even if you specifically define autism as only a set of brain differences, you still come out with a metric ton of those differences.  And they are not cookie-cutter.  You cannot slap 5 autistic brains side by side and expect there to be much by way of commonalities between them.  Grandin's book (review linked above) was pretty clear about that.

The real kicker?  Brains change.  Neuroplasticity is a long word that basically means dogs of any age can learn new tricks.  Connections between brain parts can strengthen or weaken (that is, in fact, how LENS works). Any given part of a person's brain might develop more strongly if their circumstances warrant it.  When I said brain scans are a snapshot, I quite literally meant it.  A brain scan is representative of the brain at the time it was taken.  It's silly to say we could give a long-term prognosis based on a single snapshot.  

The researchers here hoped that if they throw enough data at the computer, it'd spit out something useful.  That's not entirely unprecedented.  But it's overly optimistic to say it'd be conclusive.  The Results section is pretty dense, but the gist is that they discussed their results with the various models.  They weren't what the team were hoping for, but they remain hopeful.  

The TL;DR: brain scans are cool and very promising, but analysis of them is prone to human error.  Also, autism is not well-defined enough for this line of inquiry to yield good results.  Also also, if you're going to throw data at computers, you need a LOT of it.  A thousand or so pictures doesn't cut it.  

(Pst! If you like seeing the latest autism-relevant research, visit my Twitter, which has links and brief comments on studies that were interesting, but didn't get a whole Reading the Research article about them.)

Book Review: 22 Things a Woman With Asperger's Syndrome Wants Her Partner to Know

22 Things a Woman With Asperger's Syndrome Wants Her Partner to Know, by Rudy Simone, is a set of 22 short essays around the title's theme.  This is not a long book, at less than 150 pages.  Each essay gives a decent amount of food for thought, so this isn't a quick read despite the page count.  The tone and writing style is nearly conversational, and quite easy to follow, making this a book you could hand to pretty much anyone.  

As you might be able to guess by the label "Asperger's Syndrome" in the title, this is a book about a subtype of autism.  Specifically, women that were given the "Aspie" diagnosis rather than the "autism" or "high functioning autism" diagnosis.  Formally speaking, the difference doesn't exist any more.  The DSM 5 came out about a year after this book was published, and it erased the DSM 4R's existing autistic subtypes.  This book speaks to a subtype within one of those deleted subtypes.  

If this subtype applies to you, your partner, or your grown child, this book may be extremely useful.  It describes various facets of autistic behavior and how they may look in yourself or your loved one.  If the subtype does not apply, the book may still have some use, but it should be read with a salt shaker close at hand (ie: take the advice in these essays with a grain of salt, or in literalist terms, pay extra attention because the advice may or may not apply to your specific situation).

As for me personally?  The AsperGirl subtype seems to describe me fairly well.  Not perfectly, but enough that I'll be handing this book to my spouse and asking him to read it when I'm done with this review.  

The most useful essay for me personally was the 5th one: "Everyone's a critic... but she's better at it than you."  This is a sticking point for me and for our relationship.  I do have high standards and expectations, and those can be hard to live up to.  The essay puts those more in context, and recognizes that sometimes the autistic person simply needs to learn to lay off.  That's probably a lesson I should work on further...

I should note here that this book does not make the mistake of portraying the AsperGirl as perfect in every way, and the reader (assumed to be her partner) as simply not understanding her or not being good enough for her.  The author recognizes that a relationship is about balance, and that AsperGirls can be prone to various failings, including destructive behavior.  

Also, winning the award for Having a Clue, there was a section titled, "Even if you think of her as a woman, she might not."  There is significant crossover in the autistic and nonbinary/trans populations.  I, for example, identify as agender, which is a type of nonbinary.  And I do not consider my gender to be female.  Biologically speaking (sex), I'm female, but that's as far as that goes.  My physical parts have very little bearing on my interests, my values and initiative, and the people I care about.  This essay acknowledges this as a somewhat common.

Having read this book, I regret not looking into the AsperGirl community earlier.  I did know it existed but I guess I didn't put in sufficient time and effort to find it.  With the exception of a couple essays (one of them on motherhood), almost everything in this book accurately described me.  I can't stress enough how unusual that is for a book about autism: a diagnosis that's typically best described as a trashbin (where everything under the sun is chucked).  

Obviously, your mileage may vary.  Sensory sensitivities may vary.  Not every AsperGirl is going to be highly critical.  Coping mechanisms vary.  It's usually a massive red flag when an author gets very specific about descriptions and doesn't have too much by way of open-endedness, but in this case, for this subtype of a subtype?  Seems pretty accurate to me.  

Read This Book If

You or your loved one fit into this subtype of a subtype of autism (Aspie female or assigned female at birth), or are somewhat close. All people with autism are different to some extent, but this book fit me stunningly well.  I could see parents and professionals benefitting from this book, but its audience is very specifically loved ones of women with Asperger's Syndrome.  I did get a lot of good info out of it, which suggests I should look into other works of Rudy Simone's.  At less than 150 pages, it packs a lot of useful information without being overly wordy or wasteful of the reader's time.  Highly recommended!

Reading the Research: Throw Pills at It and Hope It Goes Away

Welcome back to Reading the Research, where I trawl the Internet to find noteworthy research on autism and related subjects, then discuss it in brief with bits from my own life, research, and observations.

Today's article is indicative of how badly the US healthcare system needs reforms.  There are a lot of failures in the supposed "best healthcare system in the world," which we'll discuss here.  The study focuses on mental illness in children.  The healthcare system affects autistic people quite a bit, and mental illness often goes hand-in-hand with developmental disabilities.  So, let's begin.  

First, this study was done entirely using the data of privately insured children with mental illnesses.  So, everyone they looked at had non-Medicaid or Medicare insurance.  This isn't often the case for autistic people, because the cost of supports often goes well beyond most family incomes.  Restricting the study data lets us see trends we might otherwise miss, though, which is why it was done.

Second, many of the studied children were in areas with sufficient doctors to serve their needs.  In rural areas, this is not always the case, and one doctor may be the only doctor for 20 miles.  Since a human can only retain so much information and there are a great deal of ailments, medical and neurological, substandard care can result.  For this study, this lack was mainly not an issue either.  

With both these facts in mind, let's now look at what happened.  Each of the roughly 200k children had their first "I seem to be experiencing mental illness" doctor visit.  It is both appropriate and important that a follow-up appointment be made and treatment options discussed with the child and their parents.  

...So naturally, about 30% of these children didn't have that follow-up appointment.  Failure 1: just having a "yep that sure is mental illness" does not help the person cope with the condition or improve their life.  30% is on average by the way.  Some ZIP code areas were as bad as 50%.  So you literally had a coin toss' chance to receive help.  

Now, on to the content of those follow-up visits.  Our best understanding of how to start treating mental illnesses is that you begin with therapy.  Many insurances cover a certain number of appointments with a therapist, though not always.  I don't personally think there should be a limit, but that's all in the name of "not wasting healthcare on people that don't need it" or something.  Spoiler: it's better to have more than enough healthcare than too little, but because insurance companies are greedy, they make us opt for as little as possible.

Getting back to the follow-up visit.  In rare instances, when the child is doing extremely poorly, a combination of medication and therapy may be recommended rather than simply therapy.  So, naturally, guess what doctors mainly did at these follow-up visits?  

Did you read the title?  Yep, it's pills.  Just pills, sometimes pills with therapy.  Failure 2: throwing pills at it does not inherently fix anything.  And, in quick succession, Failure 3: the pills prescribed tended to be the kind that were less likely to work, and with harsher side effects.  

What's going on here?  Well, it's likely a number of things.   

An ounce of prevention is worth a pound of cure, but only if your priority is actually health.  A lifetime prescription to an anti-depressant is much more reliable income than 4 years of therapy.  Or a year of neurofeedback or TMS.  The US system revolves around treating symptoms, not solving problems.  

This is a systemic thing, not any one person's fault, but we ourselves play into it.  Ads for this miracle drug or that pill are shown on TV, and people can decide they'll only get better if they have it.  So people can go in for an appointment like this, and demand pills, and the doctor may see no apparent choice but to do as asked.  I don't have statistics for how often this happens, but it's much easier to pretend a pill will solve your mental health problems than do the work of processing traumas.  (It doesn't work like that, but shhh, we're treating symptoms over here!)

However, there is one major piece aside from this that you can look into yourself.  Your doctor is legally allowed (for some reason) to take money and gifts from private companies.  Those gifts are on record, and you can find them here on ProPublica.  Look up your doctor(s).  If they've taken money, look into why.  Corrupt doctors absolutely exist, and do not have your best interests at heart.  Choose a doctor that won't sacrifice your health to make their checkbooks fatter.  

If I had to guess, it's this latter problem that explains why it was just pills prescribed, and often the wrong pills at that.  I strongly suggest you take advantage of ProPublica's work, and avoid doctors with priorities other than your health.

Regardless of the why, the results will be disastrous for these 200k children.  Untreated or mismanaged mental illness has lifelong effects.  They deserve better.  We all do.

(Pst! If you like seeing the latest autism-relevant research, visit my Twitter, which has links and brief comments on studies that were interesting, but didn't get a whole Reading the Research article about them.)

Grocery Shopping on a Special Diet: Chips and Water-Derivatives

Welcome back to my autism-aware shopping trip through the grocery store.  Week by week, I'm showing you what the store sells, prune down the selection to what's safe for me (because autistic people can have very sensitive systems) and point out various gotchas the store tries to make you buy stuff you didn't come for. 

As a reminder, I shop with the following conditions in mind:

• dairy-free
• low sugar
• avoid ultraprocessed junk
• avoid food coloring
• conditional vegetarianism
• avoid high histamine foods
• awareness of gluten-free options and sugar-free options

Last week we found sugar bombs in our "healthy" granola bars and snacks laced through our soup.  Our crackers also bled into cookies, and even the sugar-free varieties were bad news.  

It's time to delve into the second blatant snack aisle.  A truly dizzying variety of chips await!

I actually had a significant amount of trouble figuring out what the themes for each section were for the chips aisle.  Typically foods of a type are shoved together so you can find what you're looking for, but in the chips aisle it wasn't quite so clear.  Perhaps that's on purpose, to make you wander the aisle more to find what you were looking for...

At any rate, here's the first clear section.  Y'know how people like chips, and also sometimes like popcorn?  This is what happens when you combine those.  The result is actually surprisingly good, or at least I liked the Popcorners versions.  Notable also is the cauliflower tortilla chips there, which are a gluten-free option for folks that deeply miss chips.  I've never had them, sadly.  

Popcorn chips continues into veggie chips and supposedly healthier options.  Protip: these may have less oil or more fiber, but they are still ultraprocessed foods.  Opt for an apple if you want a snack that won't silently poison you.  

We now hop from "healthy" to "convenience."  Bulk boxes of both chips and cookies, attractive to moms on the go and also portion-conscientious-but-not-environment-conscientious people.  Each of those small pouches is plastic, so that adds up really fast.  

The convenience section turns into the convenience popcorn section.  Not the "make it yourself" type yet, just the big grab bags.  For those counting, this is the second popcorn section, we had the first with the popcorn chips earlier.  

Further down the way, we have our meaty snacks.  Jerky from a dozen brands, and at least seven different animal species.  Beef and pork are by far the most common, but turkey, chicken, fish, venison, and bison also feature here.  At the lower left, snack sticks by the brand Chomps, which are Certified Humane (and thus, safe for me to consume).  I actually didn't know these existed here until I perused this aisle carefully.  

And now, the cook-it-yourself popcorn, which makes this Popcorn the Third.  I count at least six brands and various levels of butter and salt.  There's also the "provide your own butter and salt" options at the very bottom, which is the healthiest option in a fairly unhealthy snack.  Humans don't actually digest corn very well, by the way.  It also doesn't contain much by way of nutrition.  

After Popcorn the Third we're back into ultraprocessed junk.  Snack mixes (including sweet ones that I guess didn't make it into the granola snack mixes and candy section?), and Combos.  

And we cap off this side of the aisle with tube chips.  They all come in cardboard tubes rather than plastic bags.  That's... better?  Maybe?  Except I guess the Stax come in plastic tubes, which is worse.  Bah.  

On the other side of the aisle, more convenience packs for the environmentally oblivious.  Lots of variety, though!

Pretzels.  I really hate pretzels, actually.  Not much to say about these except that if you like them, you definitely have options.  

Tortilla chips, plus salsa and nacho cheese.  You may have your tortilla chips in triangles, strips, big circles, small circles, and shaped scoops.  Is the absurdity of USian snacking habits striking you yet?  

Cheesy snacks.  Cheetos of various kinds, cheese puffs, nacho cheese chips, and a slice in the middle for specialty chips and snacks.  

Kettle cooked chips.  This is a particular frying process that turns out a particularly tasty chip.  Note the dizzying variety of flavors.  This is the US, after all.  

And at last, we hit what USians typically imagine when "chips" is mentioned.  Potato chips, with ripples or not.  Barbecue, sour cream and onion, salt and vinegar, or original, it's all here.  

And lastly, in case you weren't satisfied with the size of all these bags... the party section.  Complete with party-sized salsas and nacho cheeses.  A much more limited selection (and some of everything to boot), but the bag is large enough to give you several days' worth of nutritionally-deficient calories.

Next aisle!  

Juice the Second (remember the refrigerated stuff in the first post?), powdered additives for your water, and, well, water.  And products thereof.  

We start off with bottled water.  Hey, remember how the PH (how acidic or basic) of bottled water varies dramatically?  Be careful with your teeth when you buy this stuff.  Also, all those plastic bottles add up really fast, recyclable or no.  

More bottled water, with varying PHs and bottle designs.  At the top where you can't see very well, there's actually a juicebox-like design.  I truly have no idea whether it's better for the environment, but at least one brand opines that it is, I guess.

Canned, carbonated, and flavored water.  Beware the flavoring, it can come with a boatload of sugar.

Impulse buy cap in the middle of the aisle, connecting this aisle to the pop aisle.  The sale is pretty good, at least if you want these products.  

We were promised powdered drinks, and here they are.  Lemonade in powder form, various flavor additives, Kool-Aid, and hyper-concentrated liquids to color and flavor your water.  Artificial colors run rampant in this section, and so do sweeteners.  I have thankfully reached a point in my life where I'm pretty content just drinking water without extra flavor, so I typically give this whole section a miss.  It's a huge industry, though, as you can see.  

It begins!  We move from flavored "sports water" (ie: "we put salt in this and covered the ick factor with sweeteners and flavoring!") to actual flavored drinks. More on the latter later, but a reminder to beware of those sweeteners and flavorings... and also the artificial colors.   

The "sports water" becomes Gatorade and similar ideas.  Salted sweet beverages that may hydrate and refresh you, but at the cost of filling you with garbage artificial food coloring and possibly sugar.  

Let's have a look at one of these zero sugar options...  

I'll give them credit for coloring with vegetable juice, but to my complete lack of surprise, their sweetener is sucralose.  That's a big NOPE from me.  

Remember how this was the juice aisle?  We start that business with vegetable juice.  Now, you might recall that juice is a deceptive sugar-bomb from Juice the First, back in the very first post of this series.  

But surely vegetable juice is different, right?  Vegetables aren't as sweet, and they're more full of vitamins and minerals.  

Wellll, prepare to be disappointed.  This wasn't a great picture but that's 7 grams of sugar in an 8 ounce serving.  They had to sweeten this up to make it tolerable.  (Also, I've tried vegetable juice and was unimpressed regardless of the sugar content, but that's a personal preference.)  

Tomato juice is about the same deal.  I will grant you the calorie count is pretty low, but that 6 grams of sugar for an 8 ounce glass is definitely not okay.  Remember, a whole day's serving of sugar is 15 grams.  Two glasses of this and you're basically done for the day.  

Let's compare to the flavored waters, though!  Vitamin Water sounds healthy, right?  Maybe not, with those 26 grams of sugar in one single-serve bottle.  

Something a bit less deceptive?  Seems promising at first, with zero calories and zero carbs and sugars, but check what it's sweetened with: sucralose.  That's a nope.  

We get some relief from the disappointment train of this whole aisle with Sobewater, which has opted to sweeten its product with stevia.  The nutritional benefits are still minimal, but at least this product isn't going to quietly kill you when you drink it.  It's been colored with beta carotene, too, which you'll know as the same substance that gives carrots their orange color.  

Also less disappointing, Bai appears to be trying to reduce their poisonous impact while still providing a tasty beverage.  Erythritol (a sugar alcohol) and stevia sweeten this lemonade, and it's colored with vegetable juice.  I've seen worse.   

After the veggie juice comes more typical juices.  You've got your grape and your cranberry and apple, but there's also odder stuff like cherry and grapefruit.  Also cran-??? mixes.  But no peach juice, and I'm going to whine about that forever. 

As I mentioned before, juice is pretty much just sugar water with some extra vitamins.  Let's have a look.  8 ounces will net you 150 calories and a whopping 36 grams of sugar.  Yikes!  I like grape juice, but for that amount of sugar I'd rather have ice cream.  

Was the name brand any better?  Nope!  Bonus points for trying to add some fiber back into your sugar water, I guess, but grapes would make a better snack for a variety of reasons.  

Apple juice isn't much better.  28 grams of sugar and 120 calories for 8 ounces.  

The juice aisle deteriorates into stuff that's unapologetically sugar water.  So I looked into an old favorite to see how it compares.  8 ounces of artificially colored sugary garbage water will run you 11 grams of sugar and 40 calories.  What the heck?  Is this better for you than the juice?

Not really.  It's because they're cheating with sucralose on top of their high fructose corn syrup sweetener.  Definitely don't drink this.  Probably don't drink the juice, too, but definitely don't drink this.

The fruit juice-derivative products melt into unapologetic flavored sugar water, which I won't bother getting pictures of.  It's tasty and utterly terrible for you.  We all know you don't drink Kool-Aid to be healthy.  

To my distaste, though, that section finishes with convenience juice boxes, which I did snag a couple pictures of, but first, one more disappointment...

Fruit punch.  Zero sugar.  Even a mix of fruit juices.  And, right near the end of the middle... sucralose.  Curse you, drink companies!  

I have rather fond memories of this particular brand and its various flavors.  So let's look at their nutrition.  177 ml (one environmentally irresponsible pouch) is about 6 ounces of product.  You get three kinds of juice, 13 grams of sugar, and zero nutrition.  Well, at least it's honest.  

The "healthy" option.  100% fruit juice seems healthier, but as we are now painfully aware, it is not.  The healthier option has the same sized pouch, but will now cost you 20 grams of sugar instead of 13.  Yikes.  

Let's dispense with the illusion of healthiness and go find another childhood favorite.  0% juice, it says right on the box.  354 ml for two pouches divides perfectly to 177 ml, which is the same serving size as the CapriSun above.  16 grams of sugar, and it'll taste even sweeter because it's laced with sucralose.  I guess it really is worse than the CapriSun... but the best possible option so far has been the regular CapriSun.  

One more, because I couldn't resist after seeing the brand name.  Honest (Kids).  Surely it must be healthy?  It has a juice content!  (We know that means nothing now.)  

Actually, as sugar water goes, these were the best environmentally-irresponsible juice boxes in the aisle. 8-9 grams of sugar (or about 2/3rds your daily sugar intake) in 200 ml, or about 6.75 ounces.  There's no artificial colors or sweeteners, but this shouldn't be fed to children, ever.  Or humans in general, really. Maybe hummingbirds? 

This side of the aisle ends in bottled cold teas.  Various kinds, green and black and even herbal in some cases.  Many flavorings.  Most branded to tell you they're healthy.  But are they?  

Something called Pure Leaf ought to be healthy.  It's even caffeine-free so it won't keep you up at night.  What's this 27 grams of sugar doing there?  The caffeine might be missing, but this is definitely not a bedtime beverage!  Props for the very short ingredient list, at least.  Tea, sugar, extra flavor, and flower extract for color.  Too much sugar, though.  Wayyyy too much sugar.

Is the organic version any better?  If you guessed "no," you have clearly been paying attention.  20 grams of sugar is not healthy.  This is tea-flavored sugar water, and so was the first one.  

And this is where I started being really grateful I was wearing a face mask, because it's harder to read someone's utterly disgusted and disbelieving expression from the side when their mouth and nose are covered.  

"Honest" organic tea.  "Just a tad sweet."  Your "just a tad sweet" is more than my daily recommended intake of sugar, Honest.  I'll give them bonus points for using Fair Trade tea leaves and sugar cane, but I will not be putting any of this sugar water in my system or recommending anyone else do so, thank you.  

Bai again.  Remember these guys from the lemonade section?  Yeah, they're here in the tea section too, offering their spin on a less-awful-for-you tea-flavored sugar water.  Erythritol again, backed up with stevia.  If you absolutely can't give up your flavored tea drinks, this is probably your best option.

So this week we've hopefully driven home the point that sugar water is sugar water, regardless of whether it's made from juice or from high fructose corn syrup.  Juice is not good for you.  Not even 100% fruit juice.  It's all sugar bombs.  Get your vitamins from actual fruit, or a vitamin pill if you have to.

Next week it's the pop (soda, Coke) aisle and a very brief stop in the very extensive alcohol section.