His pain hits him when sitting, in his car and at his desk. His weekend guitar playing marathons might be the culprit. Sitting on our low profile bed, strums away for hour in a position that certainly looks uncomfortable. Anyway, neither sickness nor sciatica seem to deter his guitar playing or singing, so I'm glad that he is taking off a day and enjoying it. E will consult a real doctor Friday if he is not feeling better.
I'm still mid-YouTube Project, uploading and organizing videos. I was so jazzed over all the organizing, I had trouble falling asleep. Perhaps drinking 1,000 cups of tea contributed.
Life hasn't been all videos and journal transfers, though. I spent time researching autism yesterday morning. I half remembered literature about about depressed mothers and autism and checked it out. Curiously, there is something called the "broad autism phenotype," which pretty accurately sums up where our family is at on the spectrum. Am I diagnosable? Who knows, but I sure fit in on the phenotype.
Looking at heritability and autism, I found some interesting studies. The "gifted" type of autism, ie, autism where one can speak and has intellectual gifts (HFA/Aspereger's with high IQ) often presents alongside family histories of bipolar or major depression. Interesting. Dad's profoundly gifted, E and I are exceptionally gifted and we have depression and bipolar in both of our families. My dad's father was bipolar--in and out of institutions. Both Dad's mother and Egor's mother have major depression. My mom? Hmmmmm. Anxious, compulsive and coming soon on an episode of Hoarder's.
Neurodiversity. I'm lovin' it.
Would I like to change anything about my life? Be less awkward, have more friends? Not if it cost me my thoughts. I'll even keep my depression right where it is--manageable but omnipresent. I am glad for the reduction of anxiety and obsessive thoughts that Lexapro has brought. I can sleep regular hours and my life is not a 24 hour "Strange Addictions" episode, where viewers can watch me google hypochondriacally, ruminate endlessly over my own mortality and imagine vivid scenarios of the deaths of loved ones.
Below is the article I read with regards to autism and bipolar disorder. I have edited the article for readibility, you can find the article in its entirity here.
Autism and Familial Major Mood Disorder: Are They Related?
Robert DeLong, M.D., D.S.Family history studies of autism consistently reveal a large subgroup with a high incidence of major mood disorder in family members, suggesting the two entities are related clinically and genetically. (...)
Both autism and familial mood disorder give evidence of strong heritability, and both are subjects of vigorous genetic investigation. In this review I develop a hypothesis that a subgroup of the autism spectrum has a similar trait of familial mood disorder with prominent developmental and cognitive dimensions. (...)
The objective of this review is to evaluate the clinical and biological evidence relating to to a possible etiological relationship between autism and familial mood disorder. Finally, the answer must rest on genetic studies. (autism= will be used to designate the autism spectrumsubgroup associated with familial mood disorder. The term familial mood disorder includes major mood disorder (bipolar disorder (I and II), major depression, and schizoaffective disorder); obsessive-compulsive disorder and anxiety disorder were sought, but the data concerning them are less reliable.)
(...)Some of the children with idiopathic autism developed sophisticated if bizarre language, and some became competent or even precocious in one or other area of mental function (including reading or extraordinary memory feats). Some had overwhelming mood storms, and some had normal or even superior intelligence by standard testing. The sheer range of functional capacity within the group of autistic children seemed to preclude any simple formulation invoking brain damage.
At this point we noticed that an impressive number of the parents of our autistic patients had histories of manic depression. Undoubtedly we were attuned to this by our concomitant exploration of childhood manic-depression. Soon we could show, to our satisfaction, that the incidence of manic depression and major depression was significantly higher in the families of our autistic patients than in published data for the general population.
A related finding reported that socially phobic, hermitic men were common in the families of patients with Asperger's syndrome.2
We also looked more carefully at the bipolar (switching to that terminology) children we were identifying. Many of them had unusual or partial intellectual gifts or fixated obsessive interests.3 Likewise, some of the autistic children were recognized to have cyclic disorders of mood with extreme mood disturbances, sometimes responsive to lithium. In short, we became familiar with a consistent semeiological interplay between the two seemingly disparate entities.4 This was repeatedly reinforced by the family pedigrees.
Incidence of Major Mood Disorder in Families of Autistic Children
Other investigators have likewise found a robust elevation in incidence of major mood disorder in families of autistic children.5–8 The interpretations of this observation have been puzzling. Some authors have gone to great length, it seems, to avoid any implication that major mood disorder and autism might be etiologically related.7,8 In discussing their findings, they do not mention this as a possible interpretation. Piven and Palmer noted that family members of one group of autistic individuals displayed a "broader autistic phenotype," which did not include mood disorder.8 I take them to mean that they found two separate groups within the autistic probands: one with family histories of major mood disorder, and one with the "broader autistic phenotype." I am inclined to agree that idiopathic autism can be divided conveniently into two "taxa," as some have designated.9 One is higher functioning, often with preserved islands of skills and prominent anxiety, obsessiveness, mood disorder, positive family history of major mood disorder, and frequently a family history of unusual intellectual ability/achievement. The other is lower-functioning, with prominent language disability and family members having mild language disability, rigidity of personality, and related features suggesting the "broader autistic phenotype." In this taxon, however, there is a lack of major mood disorder and no family history of mood disorder or unusual intellectual ability/achievement. One caveat about this formulation is that the "broader autistic phenotype" is not fully defined, and one may suspect that it could be interpreted to include withdrawal, social anxiety, obsessive features, and the like, which may just as well be interpreted as features of major mood disorder.
Studies of the Relationship of Autism and Major Mood Disorder
Recently, others have given attention to the relationships between autism and major mood disorder. Ghaziuddin and colleagues find that depression is the most common psychiatric disorder accompanying autism (in contrast to earlier observers who maintained that depression was rare in autistic patients).10 Wozniak and colleagues, surveying 727 psychiatrically referred children, conclude that "comorbid mania among patients with PDD may be more common than previously thought", and suggest that "identification of the comorbid condition may have important therapeutic and scientific implications".11 An open trial of divalproex sodium showed benefit in patients with autism spectrum disorders, including improvement in core symptoms of autism.12 Improvement was particularly seen in those with associated features of mood instability, impulsivity, and aggression, including those without a seizure history or abnormal EEG. The implication is that the agent was acting as a mood stabilizer. We have had similar experience with lithium in children with autistic spectrum disorder.13
Comparison of Clinical Features of Autism and Major Mood Disorder
The three cardinal features of autism are 1) failure to develop communicative language, 2) failure to develop interpersonal interactions, and 3) failure to develop adaptive skills, the child being limited to a narrow range of repetitive and stereotyped actions and interests. How might these be related to primary mood disorder?
1) Language: A tentative analysis of the language deficit seen in young (2 to 7 years) autistic children follows, based on clinical observations. Clearly there is a major element of aphasia. Auditory processing is deficient leading to receptive aphasia. There is also an element of expressive aphasia, probably mixing inseparably with speech dyspraxia (thus articulatory difficulties), but also with problems in language syntax, semantics, and pragmatics. There is also, undoubtedly, an intellectual deficit that constrains language. But there are still other—mood and attentional—elements of the language deficit: mutism, negativism, and anxiety. I am referring to the child who vigilantly stares away from the examiner; who appears not to respond to voice or any stimuli, and does not speak—although at surprising and unexpected times may utter a clear sentence. After treatment with an SSRI (discussed below), or simply over time, mutism may diminish; speech utterance become freer; and syntax, semantics and pragmatics improve.2 It should be evident that affect can overwhelm cognition. This is true in major mood disorder in adults; when severe enough to swamp the perception of reality, it constitutes psychosis. It should not be surprising that the same phenomenon can occur in much stronger form in the young, in whom cognition is only beginning to take root, while emotion and mood are vigorously active. And it may not be amiss to think of autism, in some cases, as a chronic psychosis.
2) Social interaction: Likewise, failure of social interaction has cognitive and mood aspects. In the cognitive domain, the autistic child doesn't learn social cues and rules (personal space, turn-taking, appropriateness, etc.). In the affective domain, negativism, stubbornness, opposition-defiance, aloofness, aggressiveness, and anxiety (social phobia) are features. Again, these can be modified pharmacologically in some cases.
3) Repetitive, stereotyped behavior; failure of adaptive behavior: The best example of concurrence between autistic features and familial mood disorder is afforded by recent studies of "insistence on sameness" in autistic children. Hollander and colleagues show a correlation between "insistence on sameness" in autistic children and a family history of obsessive-compulsive disorder.14 And Shao and colleagues found a correlation between "insistence on sameness" and evidence of linkage to the GABRB3 gene in the chromosome 15q11–13 region.15 These two important studies illustrate in a limited sphere our basic hypothesis: there is a correlation between familial mood disorder and features of autistic disorder, susceptible to genetic demonstration.
Other Clinical Features of Idiopathic Autism
The cardinal deficits of autism can be described in other terms, and additional features can be recognized, particularly in the "mood" subgroup. Factor analyses have defined independent subgroups of symptoms. One analysis identified social communication, emotional reactivity, social orienting, cognitive and behavioral consistency, and odd sensory exploration.16 A separate factor analysis of social communication handicaps in autistic spectrum disorder identified three factors: joint attention, mood reciprocity, and theory of mind.17 Both these analyses emphasize emotional and mood disturbances, which the traditional three-part description omits. Intense narrow fixated interests are characteristic of this form of autism. The low functioning child may be fascinated with hinges or pouring sand, the high functioning child with weather, arachnids, etc. This obsessive fixation is presumably linked to the need for sameness and difficulty with transitions these children commonly show, and is also related to obsessive-compulsive disorder. Likewise, motor stereotypies may be equated to compulsive actions, generally much accentuated by anxiety.
Social phobia is a major element in autism, as mentioned above. Similarly, sensitivity to sensory stimuli, such as sounds (e.g., vacuum cleaner, sirens), texture (e.g., velvet, glass), and touch (e.g., clothing tags, wrinkle in socks, texture of foods) may be phobic.
Mood Disorder in Idiopathic Autism
Heretofore we have attempted to show that a wide range of autistic symptoms may be understood as having fundamental similarities to major mood disorder. But we can look at the issue more directly. Many idiopathic autistic children betray frank symptoms of depression. They are anhedonic or frankly unhappy and lack a typical child's usual "joie de vivre."18 These children tend to withdraw from social contact and demonstrate frustration, negativism, and irritability. They display anxiety and phobias as noted above. Even the regression that commonly heralds the onset of autism may be interpreted as the onset of depression, characterized not only by loss of language, but by social withdrawal, loss of eye contact, moodiness, tantrums, fearfulness, and occasionally self-injurious behavior. Later, in some children, the full expression of manic depression may become evident and is marked by extreme cyclicity of moods, oppositional/defiant behavior, hyperexcitement (e.g., hyperactivity, aggressiveness, rage), and vegetative signs of mania (e.g., decreased sleep, excessive fluid intake), alternating with episodes of withdrawn depression. We have designated this latter group as childhood bipolar autistic disorder. In these children, the conflation of autism and manic depression (bipolar disorder) seems clear.13
The special case of Asperger's syndrome deserves attention. In our experience, as well as others, a majority of patients with Asperger's syndrome have clinically-evident major mood disorder by adolescence.19 An unexpectedly high proportion of individuals from family pedigrees of Asperger's patients have a history of social phobia, social withdrawal, or hermitism.
Interconversion of Autism and Bipolar Disorder
Children with childhood bipolar autistic disorder, as mentioned above, are initially diagnosed as autistic and subsequently develop cycles of mood disorder typical of bipolar disorder. This occurs within a family setting of major mood disorder, usually including bipolar disorder in family members. Some of these children are eventually diagnosed as having Asperger's syndrome as they emerge from frank autism (as noted above, a large proportion of children and adolescents with Asperger's syndrome also have major mood disorder). Some emerge from autism entirely and can be diagnosed straightforwardly as bipolar. Special abilities, including the most salient savant abilities, seem to be closely related to this bipolar-autism nexus. Rare but informative autistic individuals are verbally and cognitively precocious before regressing and later become severely autistic, with bipolar disorder. Some hyperlexic children with autistic spectrum disorder develop Asperger's syndrome with bipolar disorder later in life. Some savant children lose their special abilities, becoming simply regressed autistics, often with bipolar disorder. Implicit in these case scenarios is the idea that bipolar disorder is often associated with cognitive hyperfunction—at times amounting to savant skills—which may later devolve into loss of function. As yet no adequate body of data exists to validate the foregoing.
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