July 8th, 2011

Good analysis of fraternal twin autism study

http://www.sciencenews.org/view/generic/id/332202/title/Environment_blamed_for_autism

We love Science News for a reason. Best part of the analysis:

"A total of 1,156 pairs of twins fit the criteria for the study, but the researchers ended up assessing only 202 pairs. Although the study is large by twin-study standards, the low participation rate could be a problem. “That is too low of a response rate to marketing survey research, much less an epidemiological study,” says Edwin Cook, a child psychiatrist at the University of Illinois at Chicago."

Specifically: _too low to base marketing on_. *snicker*

I wish I saw even a gesture towards the cultural constraints on receiving a diagnosis. If you can actually get a high level of participation and use a diagnostic instrument, then you can eliminate (or drastically reduce) the cultural constraints on diagnosis. But in addition to a low level of participation, I don't think they even used a diagnostic instrument; I think they just asked what diagnoses the kids (some of whom are adults now) already had (or had not) received. It's even worse when you realize the twins were born between 1987 and 2004, a time frame in which we _know_ that the diagnosis rate has changed.

ETA: While I'm here:

http://www.medscape.com/viewarticle/745890

Also a not good study (and potentially a career killer for the lead author if this thing gets the wrong kind of publicity). They compared SSRIs to tricyclics and didn't find the effect with tricyclics (never mind that the risk is really small even if it does exist, and much more easily explainable by comorbidity between ASDs and depression than anything else -- that is, mum has undxed ASD herself, is depressed because being aspie and pregnant is NOT a good combination, takes SSRIs for the depression, and has a kid with autism. Which she was going to have anyway). But _why_ didn't they find an effect with tricyclics?

"Dr. Wiznitzer, who is also the neurology liaison to the Autism Subcommittee for the American Academy of Pediatrics .. "We're only talking about 20 children who had exposure to any antidepressant, and that's an awfully small number on which to make a firm conclusion. Instead, I'd say that if this data is true, this would only be a signal that would suggest you need to study this further to determine why.""

I've got no opinion on whether one should or should not take medication for depression as a general rule; I think this is something that needs to be worked out on a case by case basis. But I sure hope that omg my kid might have autism does not come in on the don't-take-the-drug side of the decision making process. I'm pretty sure that if you have a kid on the spectrum, years of untreated depression leading up to that will only make things worse.

I'm not a hypochondriac. I swear.

I do, however, have a "Digital Blood Pressure Monitor" (funny how they don't want to use that word sphygmomanometer). I got it a decade ago (ish), for complex reasons not having a whole lot to do with me personally, but since the person I was hoping would use it couldn't/wouldn't, I figured I might as well.

In the course of using my "Digital Blood Pressure Monitor", I learned a variety of geeky things. First, that when I used to do a lot of hiking, it was definitely time to take a rest day when my blood pressure started creeping up. Second, when I was pregnant with my son, I convinced the midwives that I was really reliable about checking my blood pressure, and I would call them if the nature of the blood pressure spikes we were concerned about changes, so I didn't actually have to come in for extra visits just so they could check my blood pressure. And third, I told a different set of midwives that I really am reliable about checking my blood pressure, so they don't need to worry about that developing silently with me just because I weigh a lot more than I arguably should.

I keep the "Digital Blood Pressure Monitor" in a drawer near the chair I spent far too much time sitting in, so when it occurs to me (hey, I haven't done that in a while), I don't have to dig it out and then wait a few minutes quietly before deploying it. Pretty much by definition, if I'm in that chair, I've been sitting about as quietly as I ever do. So today, I got it out and noticed that the numbers were looking a little higher than usual (please do not panic: a little higher than usual means the diastolic was over 70. I'm still normal range). And I'm a little nutty on the subject of measurements: I do sets of three, and if something is odd, I check again later on. And it's persistently over 70 (the systolic in the earlier measurements was around 130; later on it dropped below 120. This is a not-uncommon pattern for me).

This is a puzzle. I've been decent (not great, but decent) about salt lately. I eat a lot of things like avocado, and while I've been pushing a little extra protein and iron lately because of my cycle, it hasn't been by a lot (still low end of recommended range). I don't get that much caffeine (a little green tea in the morning, some decaf tea the rest of the day and occasionally decaf coffee plus the inevitable chocolate -- and I've been consistent on this for a while, no real changes). I've been eating a lot of vegetables and taking a little cal-mag.

I think, maybe it's my period? I seem to remember noticing that pattern in the past. So mistakenly google that:

http://ehealthforum.com/health/high-blood-pressure-during-period-t163380.html

Holy moly! Okay, so I wasn't really worried, but geez. I used to check my blood pressure whenever I got a severe headache or a migraine, because I wondered about that connection. For whatever reason, my migraines had no clear association with blood pressure (weakly associated with low). I am a little weirded out, however, by the idea that there are so many women out there noticing this connection and getting a bunch of blank looks or worse from their health care providers.

ETA: On a related topic, any theories out there about male writers of books about perimenopause? I do realize I've made exceptions on the men-and-breastfeeding-books, so I could be talked into another exception -- but not several.