Autism and looking preferences: The ethics of pre-symptomatic detection

As I have written before, researchers at the Marcus Autism Center are working with eye tracking technologies to identify Autism Spectrum Disorder (ASD) in young children and infants. As Katie Strong described in this blog post, a recent article in Nature, titled “Attention to eyes is present but in decline in 2-6-month-old infants later diagnosed with autism,”[1] presented the Marcus team’s most recent findings related to the early identification of ASD traits. They argue that, although there are many different ‘autisms’ with many likely causal pathways, the developmental pathway to ASD is similar. This work is an effort to capture this pathway by focusing on differences in early looking patterns. In this article, they “propose that in infants later diagnosed with ASD, preferential attention to others’ eyes might be diminished from birth onwards”(p. 427). After a brief refresher on the article’s findings and background, I will provide a deeper discussion on the neuroethical concerns. 

This hypothesis was built on previous research showing differences in children’s and adults’ preferential looking behaviors during social situations. As Ms. Strong described in her blog, an earlier study found differences between where adults diagnosed with autism and adults without autism looked during socially or emotionally salient scenes from the 1966 film, “Who’s Afraid of Virginia Woolf?”[2] A more recent article, found that two-year-olds with a diagnosis of autism preferred to look at mouths, rather than eyes, and objects, rather than bodies.[3] From this work, the authors formulated a hypothesis that these differences were present at birth.

Some of the eye tracking results from the 2002 study using scenes from "Who's Afraid of Virginia Woolf?" The red lines show where the autistic adult looked and the yellow lines show where the non-autistic adult looked during this scene.

The current study, however, both supported and contradicted this hypothesis. Children recruited at birth had their eyes tracked while watching social videos a total of nine times between two and eighteen months of age. Of a total of 110 infants included (59 having an older sibling with autism and so at ‘high-risk’ and 51 with no 1^st, 2^nd, or 3^rd degree relatives with autism and so at ‘low-risk’), the authors did a deep analysis of the eye-tracking results of the eleven males diagnosed with autism at 36 months. Compared to the children who did not obtain a diagnosis, these children showed different looking preferences. Overall, the infants who were later diagnosed with autism preferred to look at mouths versus eyes and bodies versus objects. 

Thus, the hypothesis was confirmed as far as showing that looking differences were present early in life. However, the differences did not appear until around 6 months of age, becoming a trend at 9 months of age. The authors conclude the findings suggest that the variety of genetic and possible environmental factors that lead to a person having autistic characteristics all present with a similar developmental path early in life. Knowing that the differences in looking patterns are not present at birth, they argue, “suggests a neural foundation that may be built upon” (p. 430) for treatment. In other words, the authors suggests that if differences in looking patterns were identified in infancy then one could assume that a later diagnosis of ASD is likely and, potentially, interventions could be implemented to avoid that later diagnosis. 

This is a finding to which neurodiversity advocates object. As I have described elsewhere, neurodiversity is the concept that autism and other neurologically-based disabilities are part of the natural variation of human neurological development. This variation is necessary for human diversity and so should be neither cured nor normalized. There is a spectrum of this opinion but most adherents recognize that people with significant autistic impairment should get some sort of aid to communicate needs and achieve a higher quality of life; however, neurodiversity advocates draw the line when efforts are made to make someone’s autism diminish to the point of being unrecognizable or eliminated. 

As a neurodiversity advocate who has also been deeply involved with families struggling to find help with their significantly autistic children, I am ambivalent about these findings. I recognize that some sort of skill development is incredibly useful for many children and families. This is particularly true for children who are engaging in frequent self-harm or harming other people. I do recognize, however, that there is a fine line between this level of intervention and normalization attempts. I appreciate my autistic friends and the variety autism brings to the world. I also appreciate that people can be happy with being different. Eradicating this kind of diversity could further narrow our community’s definitions of normality and, thus, diminish acceptance for diversity. It is for this reason that neurodiversity adherents are skeptical of research aimed at intervening with the development of autism. 

Beyond the concerns of the neurodiverse community, other ethical concerns include how to accurately communicate this information to parents and the high cost of using this technology. The concern over the lack of available treatment for children showing early traits of ASD, however, spurred the most conversation. The central question being this: if we are able to detect the possibility of ASD in infancy, what will we tell parents to do? Although you can work on pre-linguistic skills in young children, there are no real interventions for that age group. While we cannot discount the possibility of the development of reliable, evidenced-based treatments, there is also a strong possibility that individuals and companies looking to profit from these findings will promote ineffective and possibly harmful treatments. The history of autism is saturated with unfounded, often dangerous treatments from holding therapy to chelation to the latest: bleach.[5] With the possibility of identifying signs of autism in infants come the possibility of unfounded infant-directed treatments.

The most likely outcome will be that the clinical world will have to grapple with the same questions the DSM 5 creators encountered when considering the inclusion of a diagnosis for risk of psychosis. Psychosis risk syndrome would have been made during the teen years and been used to identified a person as being at ‘risk’ for developing schizophrenia. Discussions about this proposed diagnosis—which was eventually rejected—brought up a host of ethical issues beyond the question of available treatments. These issues included inevitable stigma towards diagnosed individuals and the likelihood that big pharmaceutical companies would use the inclusion of this diagnosis as an opportunity to generate and market a host of unnecessary or possibly dangerous drugs.[6] There are also issues related to inevitable false positives. With both psychosis risk syndrome and the early identification of ASD traits there will be people identified who will never develop the actual syndrome. Although psychosis risk syndrome ended up being excluded from the DSM 5, early detection technologies are continually being developed and so the concerns are timely and paramount. While it could be argued that any behaviorally or socially based interventions for early ASD identification is not harmful and even potentially beneficial to children not diagnosed with ASD, these interventions are, nevertheless, costly and time consuming. 

The eye tracking technology.

It is critical for clinicians, professionals, families, advocates, and autistic individuals to begin thinking about and discussing issues related to preclinical detection. Earlier diagnosis, and even pre-natal screenings, are a close reality. 

References

1. Jones, W. & Klin, A. (2013). Attention to eyes is present but in decline in 2-6-month-old infants later diagnosed with autism. Nature, 504: 427-433.


2. Klin, A, Jones, W, Schultz, R, Volkmar, F, & Cohen, D. (2002). Visual fixation patterns during viewing of naturalistic social situations as predictors of social competence in individuals with autism. Arch Gen Psychiatry, 59(9): 809-816.


3. Jones, W., Carr, K. & Klin, A. (2008) Absence of Preferential Looking to the Eyes of Approaching Adults Predicts Level of Social Disability in 2-Year-Old Toddlers. With Autism Spectrum Disorder. Arch Gen Psychiatry, 65(8):946-954.


4. Only two girls were diagnosed with autism. Because of the low number they were excluded from analysis.


5. Bleach is being marketed as Miracle Mineral Solution (MMS). The creators of MMS claim it will cure everything from hepatitis to malaria to cancer to herpes. To find out more about the history of false cures for autism, see Offit, P. (2008). Autism’s False Profits: Bad Science, Risky Medicine, and the Search for a Cure. New York: Columbia University Press. 


6. Corcoran, C., First, M., & Cornblatt, B. (2010). The psychosis risk syndrome and its proposed inclusion in the DSM-V: A risk-benefit analysis. Schizophrenia Research, 120(1): 16-22. 

Want to cite this post?



Sarrett, J. (2014). Autism and looking preferences: The ethics of pre-symptomatic detection. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/03/autism-and-looking-preferences-ethics.html

Doing Feminist Science/Feminists Doing Science: An interview with Dr. Sari van Anders, Founder of Gap Junction Science Part II

Continued from Part I. In Part II, Dr. van Anders discusses her website, www.gapjunctionscience.org.



How did Gap Junction Science come about? Prior to Gap Junction, how did you find and network with feminist scientists?



I became really interested in the doing of feminist science – it felt very hard for me to figure things out, and there wasn’t that much community of actual feminist scientists. I wanted to develop a place where feminist science could be discussed – both practice and theory. I sometimes hear people talk about the theory as if it is practice. Of course it’s relevant, but you know what they say about theory and practice: in theory, they’re the same, in practice, they’re not. I was lucky that while I was thinking about these things, there was a call for grants at UM from our ADVANCE program for online networks in science that promote diversity. Feminism isn’t necessarily diverse, but the feminist science I envision at its heart attends to diversity. So, I wanted a space where scientists didn’t have to defend their very identity, and where feminist beliefs were a starting point, not a debate. I hoped that Gap Junction Science could be a space where feminist scientists could challenge ourselves, learn more, develop methods, and engage in a shared project. Prior to Gap Junction Science, and still, I do a lot of grassroots networking – emailing, meeting, etc. I like that ‘bottom-up’ approach and I like that now I also have a ‘top-down’ source too.

Via OffWorld Designs

How do you see visitors to the site using Gap Junction?



At first, I thought of it more as a social networking site, and this was influenced by colleagues who led other sites where the social networking features were predominant. But, visitors to Gap Junction Science seem to be doing a lot more reading than engaging, from our statistics. I think people are using it to learn more about feminism and how feminism and science could come together. After all, almost all scientific training explicitly or implicitly teaches that the two cannot come together, so I think it has more of an educational component than I first anticipated. People are reading it to try to flesh out their own understanding of feminist science and how to talk about it, explain and ‘defend’ their own passions to others, and incorporate new ways of seeing and doing into their own science.



Do you think it’s important to have female mentors? Do you see Gap Junction fostering mentorship?



I usually say that what matters is having feminist mentors. I find the point in Donna Haraway’s Cyborg manifesto as really useful here: she calls for alliances based on affinities rather than identities. So, choosing a mentor based on gender is choosing based on identity, but what does that identity represent? I don’t think all women are one unified essential group. Neither are feminists! But at least with feminism you have an inkling of the politics and sympathies and beliefs. That said, sometimes you really need identity-specific advice, and that can be hard to get from someone who doesn’t share your social location. But a good feminist mentor should be able to guide you to someone who can give you what they can’t. I will also say that I have repeatedly seen a very special bitterness reserved for mentors who share a social location but not an affinity; there’s an expectation that the mentor will ‘get’ the mentee and, when they don’t, it feels like way more of a violation. There’s nothing worse than not finding a home where you thought one would be. So, I recommend a feminist mentor and, for identity-related issues, going to someone with ‘epistemic privilege.’ That is someone who has critically engaged with their social location and positionality. In other words, find someone who has insights about the lived experiences you share, not just someone who shares the social location itself. So find someone who understands the issues you’re facing, when you can. That person is going be able to help you navigate difference in some remarkable ways. I think that Gap Junction Science kind of acts as impersonal indirect mentorship, especially about topics where local knowledge and expertise might be missing. For example, I’ve had a few colleagues now tell me that they’ve frantically read the site before teaching or giving a talk on issues around gender, sex, feminism, and science. That did my heart good! Knowing that it could be useful in that way makes me realize how much more useful I could make it to that end.

Courtesy of Indiana University

What is your vision for the future of Gap Junction Science?



Well, definitely world domination, first. After that, milkshake machines for everyone! Then, who knows?! Just kidding (never about milkshakes). We’re in the process of thinking more about this, now that we see how the site is being used in the world. We’d like to make it much more of a resource, now that I know that it’s being used that way. I’d like to see more involvement of trainees – grad students especially. I’d love to have more people involved in posting, and invested in the site. Finally, I think a major goal is to be a ‘third space’ for exploring and how-to’s of creating feminist science knowledge. My vision for Gap Junction Science is to be a place where scientists can ‘catch up’ on feminist science and where feminist scholars can engage with the day-to-day issues of feminist science as well.







Want to cite this post?



Bowers, M. (2014). Doing Feminist Science/Feminists Doing Science: An interview with Dr. Sari van Anders, Founder of Gap Junction Science Part II. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/03/doing-feminist-sciencefeminists-doing_4175.html

Doing Feminist Science/Feminists Doing Science: An interview with Dr. Sari van Anders, Founder of Gap Junction Science Part I

Dr. van Anders

*Editor's note. The title of this post is the title of Sari van Anders' talk sponsored by Emory Women in Neuroscience on March 20th. This post is the first of a two-part series.



Mallory Bowers, a 5th year graduate student at Emory University and President of Emory Women in Neuroscience, interviewed Dr. Sari van Anders an Assistant Professor in the Departments of Psychology and Women’s Studies at the University of Michigan, for the Neuroethics Women Leaders group. Dr. van Anders received her Ph.D. in Biological and Cognitive Psychology from Simon Fraser University. Her current research program focuses on “social neuroendocrinology, intimacy (sexuality/pair bonding, nurturance), evolution, health, gender/sex and sexual diversity, and research and feminist science practice." The interview will be published in a two part presentation. In Part I, she discusses her path to becoming a critical feminist scientist, the pitfalls of research on sex/gender differences, and how her work fits into bioethics.



Can you talk a little bit about your evolution as a feminist scientist - who or what influenced your feminism?



A very brief selected slice: I was reading feminist science studies in undergrad, but there were no courses on it. I was also so feminist-identified that I didn’t understand the value of taking feminist courses (I thought they were to teach feminism in general, and didn’t understand what feminist scholarship was). I knew I was interested in evolution, sex, gender, and socialization, but it seemed to me that you either studied one (sex/evolution) or the other (gender/socialization). This was actually a pretty fair assumption as there were almost no places to get mentoring about how to incorporate the two into one research program. In graduate school I was doing more work on biological determinism of sex, and then moved to social modulation of hormones. It was really hard for me to see how I could bring the reading I was doing on feminist science studies into my actual science practice, and most of the scientists who were interested in feminist scholarship had left science practice, so there were no guidelines about the day-to-day of feminist science (i.e., there was lots on epistemological approaches but almost nothing on epistemic approaches to feminist science). I kept reading and thinking, noticing little things I could do and claiming them for feminist science. In graduate school, I started an interdisciplinary group at my PhD institution to bring together people interested in gender and sex. And, I started teaching courses that brought the topics together (intersexualities; biopsychological approaches to gender/sex). Slowly it came together, with many missteps and much influence from seeing important ideas in feminist science studies, realizing how I could play them out in my work, and so on. I was already doing feminist science when I took my joint position in Psychology and Women’s Studies here at the University of Michigan, but being more immersed in feminist scholarship has been a major boon to my feminist science practice.



Karen Rommelfanger and I have discussed a bit about breaking molds as it pertains to creating roles and/or careers that don’t necessarily exist. How were you able to break the mold in terms of creating your research program? What advice do you have for individuals looking to “break the mold”?



I think one key is boldness, which I also think is an important contributor to success in science in general. I think an openness to being wrong, to looking dumb, to sharing new ideas, and for learning new languages and perspectives (not just new facts) is also critical. I think being very productive is useful, because publications are the major currency of science, so that will help people overlook your ‘eccentricities’ to some extent (and being feminist and doing feminist science isn’t not seen that way). Having minor authority issues never hurts either, when it comes to breaking molds. Finally, I remember a sort of endless search for mentors and models of how to do feminist science, and I know students are still doing this same thing. There are so few, though, that a lot of it has to be experiential and learning. When you’re breaking the mold, you may want to find another mold that fits you, but that’s the whole point of mold-breaking! There is no premade mold. You have to create your space. I think I started moving forward a lot more quickly once I realized there was no one to ask permission from, no one who was going to tell me I was on the right or wrong track, and that, yes, I would sometimes make mistakes (and hopefully learn from them). So, independence is really useful. But so is collegiality, and an interest in sharing ideas and concepts and learning from others.

van Anders 2013

Your work combines methodologies from biology and the humanities, although your background is in psychology. Was it difficult becoming proficient in reading and writing from a humanities perspective? What advice do you have for someone with wet lab training that would like to become more proficient in humanities work?



It was difficult. It took a lot of time, a lot of talking, a lot of reading, and a lot of trying. Some of my initial attempts never came to fruition because I just wasn’t ready – the ideas were ready, but I wasn’t ready to articulate them yet. My colleagues at the University of Michigan in feminist scholarship have been crucial, as have others at conferences and over email. It’s kind of like learning languages – the more immersion, the better it goes (I assume). If I let my lack of language and imposter syndrome get in the way of interacting with people, I would never have been able to eventually become fluent. So, my advice would be to read, read, read, read and talk, talk, talk, without being worried about saying the wrong things. Hold onto observations and insights until you’re ready to articulate them. And interact with humanists! Unfortunately, our training as scientists generally implicitly or explicitly teaches us that science is the only valuable epistemology in town. It’s certainly the dominant one right now, but there is so much to gain from other disciplines.



What is the biggest misconception about your research?



One misconception about my research is that the biology is biologically deterministic; I work hard to separate the two and help people understand that, though the two often overlap, they don’t need to. Another misconception is that it’s about women only. That’s an interesting one because any research with women becomes known as being only about women, even when it involves men and gender-diverse people too. So I work hard to help people understand that the presence of women among my participants doesn’t somehow erase the presence of men in my studies. Another misconception is that human research is only relevant to humans – to address this, I work hard to explain how I am studying human particularities alongside comparative insights. I see humans as both specific and as another species. In other words, I have my cake (humans are unique) and eat it too (humans are animals).



What is the most common mistake researchers make in interpreting sex differences?



The most common mistake is calling these differences ‘sex’ differences in the first place! Most human behavioral science literally has nothing to say about causal routes and whether a difference reflects innate evolved factors (like sex) or social forces (like gender). Somehow, the presence of biological measures seems to muddy this, as if the mere measurement of biology somehow precludes socialization. But biological measures and biological causation have very little to say to each other. For example, if women show one behavior-hormone association and men show another, is that because these hormone-behavior associations evolved differently? Or do they reflect very different socialization histories? It could be both or either, but a biological measure does not at all point to causation even as it’s interpreted that way. This is why I use ‘gender/sex’ to help highlight that anything we study in humans is a result of a trajectory that includes biological and social influences.

Courtesy of The New York Times

How can we overcome mistakes when it comes to interpreting sex differences – should scientists be required to take a gender studies course?



Well, what’s interesting is that this mistake – mistaking biological difference for biological causation is, arguably, a scientific mistake. Scientists should be able to recognize that correlation does not imply causation without a gender studies course. But of course feminist science studies elegantly (and depressingly) demonstrate, time and time again, that when it comes to gender, sex, and biological determinism, there seems to a ‘scientific override’ button that gets pushed. I think a critical component of addressing these issues is having more feminist construction of science alongside the important pillars of feminist critiques and deconstructions of science. We need more feminists up in there (there = science). To my mind, scientists are most easily swayed by science and biolegible arguments, so changing science is something that feminist scientists can contribute to.



How do you see your research as it relates to the field of neuroethics?



I do a lot of work on testosterone and sexual desire in social context, and this is relevant to ongoing medicalization of low sexual desire and using testosterone to treat it. My work has a lot to say about this in a way that is relevant to neuroethics, because biomedical research tends to be focused on heterosexual women’s intercourse rates with male partners. No one is prescribing testosterone to increase masturbation, increase desire for hook-ups, heighten gay men’s desire, etc. So the discussion of ‘hypoactive sexual desire disorder’ is very rooted in a view of increasing married women’s desire for penile penetration. You don’t have be a critical feminist to see those problematics at all and as ripe for neuroethics investigations.



I also think that my work calls into question the assumptions of what makes for scientific methods, measures, or questions. For example, I have demonstrated that attending to social construction – typically the sine qua non of an oxymoron if paired with science! – is critical to scientific research with hormones and social behavior. I have argued that our cultural discomfort with vaginal fluid has precluded its use in science, which has limited our ability to address important theoretical and applied questions relevant to sexual health and HIV/AIDS (van Anders 2013). And, I have used qualitative work as a model of understanding phenomena relevant to bioscience. Finally, I’ve written about thinking social for bioscientific work on bisexuality (van Anders 2012). The narrowing of our methods, measures, and questions means that neuroscience has a correspondingly limited ability to answer and ask rich questions. I think that has implications for neuroethics: how do our science-culture blinders, discomforts, and pre-theoretical assumptions lead to research that may skirt the limits of ethical practice precisely because bioscientists are taught to ignore social factors?





References

van Anders SM. Nomenclature and knowledge-culture, or, we don’t call semen ‘penile mucous’. Psychology & Sexuality (2013)



van Anders SM. From one bioscientist to another: guidelines for researching and writing about bisexuality for the lab and biosciences. Journal of Bisexuality (2012), pp. 393-403.





Mallory Bowers is a 5th year Neuroscience doctoral candidate working with Dr. Kerry Ressler at Emory University. Mallory is using a mouse model of exposure-based psychotherapy to better understand the neurobiology of learned fear. Specifically, her research focuses on a putative interaction between the cholecystokinin and endogenous cannabinoid systems that may underlie the extinction of cued fear. Outside of the laboratory, Mallory is very interested in issues at the intersection of gender and neuroscience. Mallory is the current president of Emory Women in Neuroscience (E-WIN).







Want to cite this post?



Bowers, M. (2014). Doing Feminist Science/Feminists Doing Science: An interview with Dr. Sari van Anders, Founder of Gap Junction Science Part I. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/03/doing-feminist-sciencefeminists-doing_4603.html

The next stage of neuroenhancement? Transcranial direct current stimulation

By Elisabeth Hildt, PhD



Dr. Elisabeth Hildt is a Senior Researcher, Reader, and Head of the Research Group on Neuroethics/Neurophilosophy at the University of Mainz Department of Philosophy. She is also a member of the AJOB Neuroscience Editorial Board.



Recently, non-medical uses of transcranial direct current stimulation (tDCS) which aim at enhancing brain function in healthy individuals have raised public attention (Cohen Kadosh et al. 2012; Fitz & Reiner 2013; Levasseur-Moreau et al. 2013).There are companies selling tDCS devices, and one such company is foc.us, which offers a headset for $249.00 and promotes this headset as an advantage for gaming. With slogans such as: “Use the force: Let the force of electricity excite your neurons into firing faster” or “Stronger, faster, quicker: Excite your prefrontal cortex and get the edge in online gaming”, the headset is portrayed to be a cool and trendy game add-on. However, in first assessments, the benefit of the headset for gaming does not seem obvious. In internet platforms, such as reddit, people exchange detailed instructions on how to assemble and use tDCs devices for self-enhancement. In sum, it seems that there is a community of technophilic individuals who experiment with tDCS devices for self-enhancement or who give instructions for assembling do-it-yourself tDCS devices.



 In view of this, the question arises: Why do individuals engage in this kind of tDCS self-experimentation? A motive often mentioned is to improve gaming performance or to increase gaming experience; for technology freaks, high performance in a virtual world seems to be very rewarding. People seem eager to experiment with the devices and to present their results to the internet public, to get in touch with other technophiles or to gain credit in the community. Another motive is to write a widely read article in a blog or newspaper on a new and captivating subject, such as recent articles in Aeon magazine or in the Guardian. Some people may aim at being a pioneer in a very fascinating technical field, while others seem to self-experiment just for fun. tDCS self-experimenters seem to be fascinated by the prospect of being able to boost their brains, of having some exceptional feelings of going beyond their limits.



Given the context described above, it seems that the individuals involved assume that the non-invasive procedure tDCS does not imply significant health risks. However, it is important to stress that the tDCS applications mentioned above are premature uses of a technology originally designed for medical purposes in clinical contexts. Up until now, very little is known concerning the risks of tDCS for healthy individuals. These include short- and long term risks of repeated tDCS use in healthy individuals, but also negative effects brought about by disproportionate stimulation protocols or the stimulation of inadequate regions of the brain (Levasseur-Moreau et al. 2013; Sehm & Ragert 2013; Fitz & Reiner 2013). Notably, in the tDCS community there are also cautious voices underlining these problematic issues.

An advertisement for the foc.us tDCS headset.

The situation with regard to tDCS self-enhancement reminds me of the beginning phase of pharmacological neuroenhancement, i.e. the use of drugs, in particular of stimulants such as Ritalin or amphetamines, in order to increase mental performance, to get high, to experiment, to party, etc. With pharmacological neuroenhancement, lots of individuals in various parts of the world also enroll in self-experiments without having reliable information on the benefits and risks of the drugs used. It seems that with tDCS a very problematic process is about to be repeated again, this time at another level. When pharmacological neuroenhancement became public, there were very positive reports in the media and in literature on putative enhancement effects which seem to have encouraged people to try stimulants, too. Rightly, this has been criticized later in the interdisciplinary literature by various authors. Among the insights that followed from this is one that states that it is the responsibility of everybody, including scientists, journalists and other people alike, to give a balanced picture of the situation.



In spite of this remorseful debate led in the past, it seems that in the context of tDCS, things are rather similar now. It is again sensational reports that coin the field, this time not often written by journalists or scientists, but by self-experimenting individuals or industrial companies. These reports are facilitated by the fact that in contrast to illegality of the use of prescription or illicit drugs for pharmacological neuroenhancement, there currently is a lack of regulation concerning nonmedical tDCS uses (Fitz & Reiner 2013), which allows a broad spectrum of commercial and non-commercial promotion. Taking this into account, there is a clear need for developing a strategy right now which helps to cope with the societal challenge of non-medical tDCS uses. This includes running a more balanced and scientifically informed debate on the chances and risks of putative tDCS enhancement in healthy individuals, and to seek regulations which serve to guide a field that undoubtedly will be difficult to regulate considering the fact that tDCS can be easily assembled and used.





References



Fitz NS, Reiner PB. (2013). The challenge of crafting policy for do-it-yourself brain stimulation, J Med Ethics, Online First: [June 3, 2013], doi:10.1136/medethics-2013-101458.



Cohen Kadosh R, Levy N, O'Shea J, Shea N, Savulescu J. (2012). The neuroethics of non-invasive brain stimulation. Curr Biol. 22(4):R108-11.



Levasseur-Moreau J, Brunelin J, Fecteau S. (2013). Non-invasive brain stimulation can induce paradoxical facilitation. Are these neuroenhancements transferable and meaningful to security services?, Front Hum Neurosci.7:449. doi: 10.3389/fnhum.2013.00449.



Sehm B, Ragert P. (2013). Why non-invasive brain stimulation should not be used in military and security services. Front Hum Neurosci. 7:553. doi: 10.3389/fnhum.2013.00553.





Want to cite this post?



Hildt, E. (2014). The next stage of neuroenhancement? Transcranial direct current stimulation. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/03/the-next-stage-of-neuroenhancement.html

Lumosity: a "personal trainer for your brain"?

Is intelligence more like height or strength? Could high school students improve their IQs in time for the college entrance exams with a few weeks of “brain training” like college students pump up their biceps before spring break? For many years, psychologists believed that intelligence, and particularly fluid intelligence, is for the most part a fixed quantity – somewhat like height. Fluid intelligence, which is thought of as the ability to perceive patterns amongst noise, understand meaningful connections, and analyze information in the moment is a strong predictor of future success yet has been remarkably resistant to training¹. In a way, this sounds strikingly similar to what neuroscientists once said about the biology of the brain (i.e. neurons don’t regenerate after injury and they are only lost, not added throughout life). Now we know that the brain is incredibly plastic and that new neurons are produced even into adulthood². So, why wouldn’t an aspect of intelligence, undoubtedly a product of the dynamic brain, also be mutable? Recently, a lucrative new industry has aimed to capitalize on this notion. Web-based programs such as Lumosity.com have grown rapidly. They aggressively market their services with the assertion that they are backed by neuroscience but with a decidedly fad-diet feel. Who wouldn’t want to “unlock your inner genius”?

The human brain may in fact be the “most complex object in the universe”. There are 10¹¹ neurons (not to mention glia) which, though once thought to be static, are quite plastic and modulate their several thousand connections (each) based on activity in terms of both structure (anatomy) and function (connection strength)³. These processes can occur during learning or recovery from injury. Add to this the relatively recent discovery that new neurons are produced in the brain throughout adulthood and it seems that the possibilities for changing the brain are nearly limitless^2,3. The idea that the brain could be trained like muscle, in a way, was born out of this new understanding of neuroplasticity along with data from psychologists suggesting that intelligence is not as fixed as was once thought.



This idea has really caught on. In fact, the brain training industry is booming. Lumosity, a company that offers a “personal trainer for your brain,” claims to have more than 50 million users worldwide. Although the concept of adaptive working memory training was initially conceived as an alternative intervention for ADHD⁴, it is now very much marketed to professionals for (workplace) performance enhancement akin to how Viagra and the like buy up airtime on ESPN. Lumosity’s ads promise “improved brain performance” after use of their “neuroscience-based games” and lately can be heard after nearly every segment on NPR.

Observers have traced the roots of this industry back to Torkel Klingberg’s 2002 paper in the Journal of Clinical and Experimental Neuropsychology⁴ in which a cohort of children with ADHD, and also an unaffected group of young adults, showed improvements in working memory (working memory is, for example, the ability to remember a grocery list while you’re shopping) and scored better on Raven’s progressive matrices (a test of general cognitive ability) after five weeks of regular training with an adaptive working memory task. Klingberg went on to found Cogmed, one of the first brain training companies, which was sold to Pearson education in 2010. Sharpbrains.com has estimated that the brain training market surpassed $1 billion in 2012 and could reach $6 billion by 2020. So what is all the hype about?



Brain training promises a simple approach to a complex issue and perhaps that is why it appeals to so many people. Essentially, the underlying premise is that training on specific working memory tasks will translate to overall improvements in reasoning ability and general cognitive performance, just as a basketball player spends hours lifting weights to improve all-around strength and thereby performance on the court. With training it is no surprise that ability in the bench press increases, but does the brain also work this way? Can training on specific working memory tasks – weight-lifting in this analogy – translate to improved reasoning ability and general cognitive performance? The central question is whether individuals who play these training games are simply getting better at the training tasks, through practice, or if these people are actually getting smarter.



While there is a great deal of interest in answering this question, the results have been somewhat inconclusive. Since Klingberg’s 2002 study, there have been many high-profile articles providing support for both sides. One of the most influential papers was Jaeggi and Buschkuehl’s 2008 study published in PNAS⁵ which suggested that not only could fluid intelligence be improved with working memory training but also that these mental exercises could yield an increase of nearly a full IQ point per hour. Recently, however, the enthusiasm has been tempered somewhat by several prominent studies with negative results. A group at Georgia Tech was unable to replicate Jaeggi and Buschkuel’s results⁶ and some in the field have even taken to the popular press to express skepticism of these findings⁷. Perhaps more troubling for the industry, a large study of more than 11,000 online brain training users published in Nature found no effect of these exercises on general cognitive abilities despite significant improvements on the training tasks themselves⁸. Finally, 2013 meta-analysis⁹ found that, at this point, the evidence across the literature is not sufficient to conclude that adaptive working memory training improves intelligence or even training task performance beyond a few months (and there was no overall effect on working memory across all studies at the average 9 month follow-up).



However, in some cases the question of whether improvements in working memory generalize to increased intelligence may not be all that important. For example, Klingberg’s original study measured the effects of working memory training on children with ADHD⁴. While it would be great if these training tasks could improve reasoning ability and fluid intelligence, a significant enhancement in attention span alone would likely improve school performance and could make these programs a welcome alternative to psychostimulant pharmacotherapy. In this case, increased ability in attention-based training tasks alone would likely make the effort worthwhile and IQ gains would essentially be a bonus. It should also be noted that measurement of intelligence itself is subject to significant controversy¹⁰. Raven’s progressive matrices, a standard nonverbal test of reasoning ability and fluid intelligence used in Jaeggi and Buschkuel’s study⁵, certainly does not cover the entire spectrum of cognitive ability nor does it necessarily predict school or job performance. One study using this test found that a cohort of children diagnosed with Asperger’s disorder significantly out-performed typically developing children with similar IQ scores¹¹.

Nonetheless, those of us who are buffeted by the ubiquitous advertising of brain training companies like Lumosity can’t help but think that there must be something to this because, after all, these are “neuroscience-based” games. What is the scientific basis for Lumosity’s claims? Their website advertises 15 “completed” studies but eight of these are posters that may or may not have been reviewed by a panel before being presented at conferences. In some conferences in the biomedical sciences, at least, conference posters are very rarely rejected simply because their presenters are a good source of revenue and it is thought that the merits of the poster will be judged by other attendees¹². Posters typically present preliminary findings and are not subject to the same rigorous peer-review as published articles and thus would hardly be considered complete. Seven of these eight posters report data collected at Lumos Labs by Lumosity employees. Still, five peer-reviewed papers have been published. However, one was authored by an internal research group headed by the senior director of research at Lumos Labs¹³ and appeared in Mensa Research Journal which, according to their website, is “primarily a reprint publication” and not typically an outlet for high-impact research. A second was a pilot study from an Australian group that had only one significant finding in the Lumosity-trained group – an improvement in a measure of visual attention¹⁴. Finally, three additional papers have been published by a group at Stanford led by Shelli Kesler studying effects of these programs in very specific groups such as post-chemotherapy cancer patients^15-17. Two of these were pilot studies without control groups^16,17, and a third found significant improvement in measures of executive function immediately following Lumosity training compared to an un-trained control group (which received no mental exercise of any kind)¹⁵. While these data may seem promising, the preliminary nature of these studies and lack of real controls make it difficult to come to any conclusions as to what effect the training actually has.



This is the fundamental problem with the industry – the science simply does not (yet) back up their claims. By aggressively advertising an under-studied product, Lumosity is setting high expectations for users. These exercises may in fact work in some way for a great number of people, but if it were as easy as their claims make it seem, wouldn’t the data be much clearer? As a neuroscientist, it is also difficult not to take issue with their overuse of the term “neuroscience” itself. Unfortunately it is cheapened when applied to commercial products like these, which seem to take a page out of the fad-diet industry’s book by seductively promising that science has found a new, easy way to a better you. If in 10 years the idea of brain training becomes laughable to a critical general public, will neuroscience as a field be dragged down with it? Clearly, Lumosity believes that the term neuroscience carries some gravitas, because most of the research they cite, and most of literature on brain training, actually comes from psychology methodology, rather than biomedical research techniques. There was indeed a revolution in neuroscience brought on by the discovery of neuroplasticity (in truth an abstract term that is more globally applied to numerous phenomena related to the brain’s ability to change and adapt), but that was decades ago and the neurobiology of intelligence, at the cellular and molecular level, is still poorly understood¹⁸.



On the surface it may seem that there is no harm in using these programs, but there is always a cost. In this case, it may be time that could be spent doing something else that is known to sharpen mental acuity and brain health, like physical exercise¹⁹. In addition, Lumosity researchers collect data on users’ performance (and are essentially paid by users to collect this data, rather than the other way around) and then share it with researchers around the world. Is this the future of big science or are Lumosity users just paying a for-profit company to collect (and share) data on their cognitive abilities*? The scientific literature shows that there is hardly a consensus as to whether fluid intelligence can be reliably improved through training of any kind, and therefore it may in fact be more analogous to height than strength. Still, companies like Lumosity disregard this and offer a “personal trainer for your brain.” Perhaps the biggest danger is that these companies misrepresent how science actually works, to a very wide audience, and could undermine the public’s trust of scientific integrity, which is already enough of a problem. Real progress in science results from rational, hypothesis-driven research, which is subjected to replication attempts, peer review, and ample skepticism – particularly from the investigator. The hope is that brain training programs do, in fact, work. Of course, it would be nice to unlock that inner genius. However, as consumers and as the primary funders of natural science research, the public deserves much more of the full story.



* From Lumosity’s privacy policy: “we collect and store data about the games you play and your performance in those games. We may also collect and store information such as your browser type, IP address, language, operating system, unique device identifier, the date and time of your visit, the pages you view and the websites you visited immediately before and after visiting Lumosity.”





References



1. Shipstead, Z., Redick, T. S. & Engle, R. W. Is working memory training effective? Psychological bulletin 138, 628-654, doi:10.1037/a0027473 (2012).

2. Gage, F. H. Neurogenesis in the adult brain. The Journal of neuroscience : the official journal of the Society for Neuroscience 22, 612-613 (2002).

3. Lledo, P. M., Alonso, M. & Grubb, M. S. Adult neurogenesis and functional plasticity in neuronal circuits. Nature reviews. Neuroscience 7, 179-193, doi:10.1038/nrn1867 (2006).

4. Klingberg, T., Forssberg, H. & Westerberg, H. Training of working memory in children with ADHD. Journal of clinical and experimental neuropsychology 24, 781-791, doi:10.1076/jcen.24.6.781.8395 (2002).

5. Jaeggi, S. M., Buschkuehl, M., Jonides, J. & Perrig, W. J. Improving fluid intelligence with training on working memory. Proceedings of the National Academy of Sciences of the United States of America 105, 6829-6833, doi:10.1073/pnas.0801268105 (2008).

6. Redick, T. S. et al. No evidence of intelligence improvement after working memory training: a randomized, placebo-controlled study. Journal of experimental psychology. General 142, 359-379, doi:10.1037/a0029082 (2013).

7. Hambrick, D. Z. in The New York Times    SR4 (2012).

8. Owen, A. M. et al. Putting brain training to the test. Nature 465, 775-778, doi:10.1038/nature09042 (2010).

9. Melby-Lervag, M. & Hulme, C. Is working memory training effective? A meta-analytic review. Developmental psychology 49, 270-291, doi:10.1037/a0028228 (2013).

10. Weinberg, R. A. Intelligence and Iq - Landmark Issues and Great Debates. Am Psychol 44, 98-104 (1989).

11. Hayashi, M., Kato, M., Igarashi, K. & Kashima, H. Superior fluid intelligence in children with Asperger's disorder. Brain Cognition 66, 306-310, doi:DOI 10.1016/j.bandc.2007.09.008 (2008).

12. Erren, T. C. & Bourne, P. E. Ten simple rules for a good poster presentation. PLoS computational biology 3, e102, doi:10.1371/journal.pcbi.0030102 (2007).

13. Hardy, J. L., Drescher, D., Sarker, K., Kellett, G., Scanlon, M. Enhancing visual attention and working memory with a Web-based cognitive training program. Mensa Research Journal 42, 13-20 (2011).

14. Finn, M., McDonald, S. Computerised Cognitive Training for Older Persons With Mild Cognitive Impairment: A Pilot Study Using a Randomised Controlled Trial Design. Brain Impairment 12, 187–199 (2011).

15. Kesler, S. et al. Cognitive training for improving executive function in chemotherapy-treated breast cancer survivors. Clinical breast cancer 13, 299-306, doi:10.1016/j.clbc.2013.02.004 (2013).

16. Kesler, S. R., Lacayo, N. J. & Jo, B. A pilot study of an online cognitive rehabilitation program for executive function skills in children with cancer-related brain injury. Brain injury : [BI] 25, 101-112, doi:10.3109/02699052.2010.536194 (2011).

17. Kesler, S. R., Sheau, K., Koovakkattu, D. & Reiss, A. L. Changes in frontal-parietal activation and math skills performance following adaptive number sense training: preliminary results from a pilot study. Neuropsychological rehabilitation 21, 433-454, doi:10.1080/09602011.2011.578446 (2011).

18. Gray, J. R. & Thompson, P. M. Neurobiology of intelligence: science and ethics. Nature reviews. Neuroscience 5, 471-482, doi:10.1038/nrn1405 (2004).

Cook, G. in Elements blog, newyorker.com    (2013).





Want to cite this post?



Purcell, R. (2014). Lumosity: a "personal trainer for your brain"? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/03/lumosity-personal-trainer-for-your-brain_4.html