About this blog.

My son was diagnosed with PDD-NOS at 24 months. I created this blog to bring meaning to the often-confusing label. Sometimes I have answers. Other times, just more questions.

Friday, November 6, 2009

"Pruning"


When it comes to interventions, much is written about "rewiring" the brain - the theory (and, for some, hope) that intensive interventions can cause an atypical child to be more neurologically typical. Is rewiring possible? I don't think anyone knows for certain.

But it is well settled that you can work with the wires you already have. During childhood, the brain undergoes a pruning process, during which underused neurons and synapses simply die off. This is perhaps the best argument for early diagnosis and early intervention. With early intervention, perhaps we can prevent some of those tenuous synapses from dying off, and the sooner we start, the better the chance for a positive outcome.

With that in mind, in the coming weeks, I will blog about interventions that we have tried. In the upper right, I indicate that we use "moderate interventions." I'm going to try to give that vague statement a little more shape, speaking of course from a parenting/anecdotal POV.

First, a prefatory note about goals. Because, of course, as any special needs mom or dad with an IEP knows, you need to start with goals. About one year and nine months ago, if you had asked me about my goals for Brad, I might have replied that there is only one and that it is that he acquire speech. Flash forward about six months later, I started thinking more about social pragmatics and empathy. I added warmth and humor to the list of goals for Brad. Today, on a high level, my goals for Brad have shifted to intellectual capacity, i.e. making those higher order connections and doing whatever we can today to avoid intellectual disability down the road. Not that communication and warmth and humor aren't goals for Brad - they most certainly are. But I no longer fear that Brad won't acquire speech or develop empathy.

6 comments:

K said...

I love the way you are thinking about it
The reading I have done on Neural Pruning ( I think its Purkinje ones) is actually that is auties the neurons are not pruned back which is the problem
That is - too much stuff is getting in - which equals too much noise and so the back and forth interaction that needs to happen between child and parent does not happen

Nyx said...

First, you are so awesome. I also love the way you think, and it exactly tracks the way my goals have traveled, although I am still worrying about empathy. A nameless Autism Center in my city likes to throw the word rewiring around a lot, but when we asked them exactly what they meant, they said they meant developing skills to better cope or compensate. I think the term is used rather loosely by many. But I have always imagined that in addition to pruning, there is the need to grow the branches a little faster ... while my boys were infants I read a book called "what's going on in there?: how the brain and mind develop in the first five years of life," and it seems like the author described a real exponential growth pattern for early neuronal development, so that if an infant for whatever reason gets behind ... well, they just keep falling further and further behind compared to an infant who started down the path properly ... As I read about the development of joint attention recently, I began to get the idea that he may have fallen behind as early as 4 months old, after which he just got further and further behind and it took me over a year to figure it out. So now ... well, the same book said many studies have shown that caregiver guidance and stimulation makes an enormous difference in how rapidly the brain develops, so my theory is to just keep working him hard. But I do wonder ... there are only so many hours in the day, truly, so if you spend 6 hours a day on social, to catch him up as it were, is he falling behind in something else? I am looking forward to the rest of this series. This blog is the best.

Laura said...

thanks! K, and I appreciate your perspective too (and your humor). So the flip side of the coin is the overdeveloped areas of the brain.

Nyx, aw shucks, well we're basically bloggy soulmates in terms of the age of our children and our profession. ha! I own What's Going on In There too. I bought it when Jeremy was born. And yes, I think it starts when they're infants, and snowballs a bit, without interventions.

Nyx said...

oh, if only I could download directly into my brain all of your research and experience!

rhemashope said...

I have never met Brad in person but I sure do see "warmth and humor" in the pictures and video clips! I honestly love that boy.

Pruning is kind of a sore subject for me - it drudges up all those old fears. But I hold on to hope that dying synapses can be resurrected. =)

Emily said...

I'm so glad to hear Brad is making so much progress!

I'm with Nyx, I bet it's about new neurons growing and making connections, too.

My experience is like Nyx's, most of the clinical people who tell me they "rewire" just mean the same old compensating skills, but "rewiring" sounds cool and brings in the customers. My reaction is, why go to a special clinician then, since parents, teachers, friends, community members, self-help books, etc. can teach you to compensate for free? Yeah, learning how to compensate affects the brain, but so does everything else you do; there's no magic about things affecting the brain.

I think part of the issue is even researchers don't really know how pruning works. They're trying to understand a global process related to interactions with the environment (which they might not even look at) and genetics (which we only kind of understand). And how do they do it? By looking at micro-scale effects of X chemical on Y chemical in Z synapse, often not even in humans. When the scientists don't even know, of course you'll get neurobabble. :)