What you missed at BRAINet: The Many Brains in Music

The Brain Research Awareness and Information Network (BRAINet) is the volunteer outreach organization of the OHSU Brain Institute. BRAINet Lecture Luncheons are held each month, where members can hear presentations from OHSU faculty members.

On December 15, we we lucky enough to be joined by Larry Sherman, Ph.D., who spoke about the connections between music and the brain. Dr. Sherman is both an accomplished musician and Senior Scientist for the Division of Neuroscience at OHSU’s Oregon National Primate Research Center.

What did we learn?

The brain is a “use it or lose it” organ. Music is just one way to keep pushing it as we grow older. As we age, formation of the new neurons in our brains slow down. Synapses become weakened or destroyed and myelin–the material that coats, protects, and insulates nerves–becomes damaged. All of these changes contribute to age-related sensory, motor and cognitive decline. These changes are also accelerated in patients with Alzheimer’s disease and other neurodegenerative conditions.

Could music influence each of these processes?

Dr. Sherman thinks so. Music crosses the cultural divide and commonalities between vocalizations are found across the world. Mothers instinctually sing to their children. Children use the same sing-song vocalization when they taunt “nyah nyah nyah nyah.” The brain’s processing of music happens quickly, nearly immediately.

Dr. Sherman played a series of notes and asked the audience each time to sing the following note. Each time, the audience was able to discern what came next, even in an unfamiliar scale. It was surprisingly easy to adjust each time the music shifted.

There is great evidence that shows that playing a musical instrument increases neurogenesis, or the generation of new neurons. Practicing a piano for just eleven minutes a day shows an increase in white matter in the brain, where myelin is located. Those over the age of 70 who focus on learning and development also show stronger myelination. There are also indications that just thinking about how a certain piece of music is played can have an impact on myelination.

Find out more about BRAINet and how you can get involved. 

Want to know more? Watch video of Larry Sherman presenting at OMSI or listen to a podcast about the brain.

The connection between the brain, sleep and dementia

Last week, I talked about ongoing research on how sleep “deep cleans” your brain, as well as my participation in the National Geographic Channel’s documentary Sleepless in America.

Meanwhile, our team of OHSU researchers, along with colleagues at the University of Rochester in New York, are plunging ahead with the story of the brain, sleep and dementia.

We recently published an article in the journal Annals of Neurology that showed that the “brain cleaning system” is impaired in the aging brain, and that this impairment is associated with an inability to properly clean out the proteins built up in the brains of people with Alzheimer’s disease. This suggests that the brain’s inability to “keep its house clean” may be one of the factors that makes the aging brain vulnerable to neurodegenerative diseases like Alzheimer’s.

New findings show that the same processes may also be at work in the aging brain and in the young post-traumatic brain. This month, we published an article in the Journal of Neuroscience showing that the system is similarly impaired in the young brain after a traumatic brain injury (TBI). Recent clinical studies show that suffering a traumatic brain injury early in life increases your chances of developing dementia, including Alzheimer’s disease, in the decades that follow.

We’ve heard a great deal recently in the news about former football players suffering from an Alzheimer’s-like condition called chronic traumatic encephalopathy, or CTE. Yet we haven’t understood what it is that happens after brain trauma that sets the stage for neurodegeneration later in life.

This research is ongoing and emphasizes the fact that sleep is indeed essential to the basic function of the brain. For more information, and to stay up-to-date with our most recent neuro-research, visit ohsubrain.com or join the conversation on Facebook.

And for more on sleep, don’t miss the National Geographic Channel’s “Sleepless in America.” The full episode is now available online!

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Jeffrey Iliff
, Ph.D. is an Assistant Professor of Anesthesiology and Perioperative Medicine and works with the Knight Cardiovascular Institute and the OHSU Brain Institute.

 

Sleepless in America — and the science behind it

There’s nothing quite like that feeling in your head after a long night of…no sleep.

Your head feels disorganized, foggy, fuzzy, jumbled.

Like it’s full of sludge left over from the night before. That’s maybe because it is.

My colleagues and I have made some recent discoveries about what happens to the brain during sleep. In essence, we’ve found that the brain’s cells shrink during sleep in order to open up the space between them. That space allows cerebrospinal fluid that surrounds the brain to wash through it, flushing out debris and waste.

When the brain is asleep, this process allows the brain’s waste material to be cleared out at 20 times the rate of an awake brain! Our findings have given the scientific community a new understanding of sleep, and provide new insight into how this process — or the impairment of it — may be linked to dementia.

Our research recently attracted the attention of producers working on a documentary about sleep, which is airing now on the National Geographic Channel. I was interviewed for the documentary, called Sleepless in America. The film takes an in-depth look at not only the science of sleep, but also the severe societal impacts of tens of millions of Americans not getting enough of it.

Slowly, we’re building a better understanding of the complex nature of sleep — how good sleep, bad sleep, aging, and brain injury could be affecting our brains in profound and long-lasting ways.

Sleepless in America first aired Sunday, Nov. 30, and is set to air again on Dec. 7.  I hope you’ll tune in!

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Jeffrey Iliff
, Ph.D. is an Assistant Professor of Anesthesiology and Perioperative Medicine and works with the Knight Cardiovascular Institute and the OHSU Brain Institute.

 

 

 

 

Learn more:

The Washington Post:
No, you’re not sleeping enough, and it’s a big problem: 15 scary facts in new NatGeo doc

National Geographic Channel: 
Sleepless in America
Encore presentation on Sunday, December 7, 2014, 9 a.m. 

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There’s an app for that! How mobile devices can help memory and planning

Over the last few years we have had a surge in the availability and affordability of “apps” or programs that can run on your phone, tablet or other mobile device.

Many apps promise to make life easier and more convenient. It is sometimes difficult to know if the app stands up to those claims, or whether it would just be easier to set an alarm by the bed, look at a paper calendar on the wall—just like in the good ol’ days.

I think it is best to at least try some new things and choose what works best for you. You may be surprised at how easy many of these apps are to use and how they really can help you.

MEMORY – Memory aids such as lists, diaries, clocks and clear, written instructions can help jog your memory. 

Pill Time – $0.99. Helps you keep track of medicine and remind you when you need to take them. It takes a while to get them all entered, but once you do it is fairly easy to use. There are lots of pill reminder programs. Find one that fits you the best.

Spaced Retrieval TherAppy – FREE. So you did spaced retrieval with your speech therapist and now you want to do more at home with your loved one? Use this app to track how long items have been recalled for and what the next interval should be.

COGNITIVE EXERCISES – Brain training exercises to help with your brain’s ability to learn and think. 

Lumosity – FREE. Features include: daily games, a good introduction if you are considering the full online version ($14.99/month). Fun and easy to use.

BrainHQ – FREE. Features include: daily games, also a good introduction to the full online version.

MINDFULNESS/RELAXATION – Beneficial for many things such as disease and pain management, sleep, and control of emotions.

Breathe2relax – FREE. Originally developed for Veterans returning with PTSD. This app allows you to complete breathing for relaxation exercises with visual and auditory instructions

The Mindfulness App – $1.99. Takes you through several relaxation exercises.

PLANNERS/ORGANIZERS – Keeps all the important things in one place. 

Things. $9.99 – A good task manager- it helps get life done. Features include: to-do lists with reminders, projects with specific action items, daily to-do.

Evernote – FREE. Organizes information across devices. Set tasks, reminders,appointments, take notes, pictures.

PARKINSON’S SPECIFIC

AppSPD life – FREE. Developed by the Parkinson’s Association of the Rockies. Features include: Record all of your medications and dosages, schedule reminders to ensure you take your medications on time, track and improveyour ability to take medications on time, track and report timing of your “On/Off” periods, track and report your symptoms and side effects, track and report your “PD Life Score”, take your device with you to your next healthcare visit – make it part of your normal healthcare dialogue.

Parkinson’s Central Smartphone App – FREE. National Parkinson’s Foundation. Features include: “Near Me” tool to find resources in your area, how to get the most out of doctor visits, ins and outs of diagnosis and medicationmanagement, tips on how to live well with Parkinson’s, information about insurance and finance, special caregiver content.

Most of these programs are available in both Apple and Android formats.
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Rubin, Michal_14

 

Michal Rubin, CCC-SLP is a speech-language pathologist who specializes in rehabilitation of language, speech and cognitive-linguistic deficits.  She currently works at OHSU’s Outpatient Rehabilitation Services Department.

 

 

 

 

OHSU earns top honors for stroke care

Quickly administering the clot-busting, brain-saving drug t-PA to restore blood flow to the brain. Treating acute ischemic stroke patients with medications that prevent the formation of additional blood clots, when it’s safe and appropriate, 100 percent of the time. Exceeding the American Heart Association/American Stroke Association’s quality measures 95 plus percent of the time.

These are a few of the reasons OHSU has earned top honors for its stroke care for the eighth consecutive year.

The American Heart Association/American Stroke Association (AHA/ASA) presented the OHSU Stroke Center with its Get With the Guidelines® Stroke Gold Plus award Oct. 22 in recognition of our excellent stroke care. The Gold Plus award is the top stroke treatment honor and recognizes hospitals who meet all seven Get With the Guidelines® Stroke Achievement Measures at least 85 percent of the time and five or more Get With the Guidelines® Stroke Quality Measures at least 75 percent of the time. And to get the gold, hospitals like OHSU must meet these standards for 12 consecutive months. As noted earlier, OHSU exceeded the AHA/ASA standards by achieving 95 percent or better compliance with these measures.

In addition to quickly administering clot-busting drugs and treatments that reduce the risk of future strokes, OHSU provides a full array of advanced stroke treatments. This includes carotid stents, carotid endarectomies, aneurysm clipping and coiling, as well as recovery in our state-of-the-art Neurosciences Intensive Care Unit.

OHSU also meets the rigorous standards laid out by the Joint Commission for Certified Comprehensive Stroke Centers for each of the 600 ischemic and hemorrhagic stroke patients we care for each year. And the OHSU Telemedicine Network extends stroke treatment expertise to more than 150 patients at community hospitals throughout Oregon each year. This allows patients to receive specialty stroke care more quickly and reduces unnecessary and expensive patient transfers by 40 percent. In addition, 40 percent of these telestroke patients receive advanced stroke treatments such as t-PA and/or clot removal procedures because their hospital is connected to OHSU’s stroke neurologists via telemedicine.

These efforts, along with the recognition we receive from both the AHA/ASA and the Joint Commission, confirms that OHSU consistently provides the highest standard of care for stroke patients.

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Karen Ellmers, R.N., M.S., C.C.N.S.
OHSU Stroke Program Coordinator

New stroke guidelines may help women reduce their risk

Stroke has a big impact, no matter your sex. Yet stroke affects more women than men: According to the American Heart and American Stroke Associations, of the 6.8 million stroke survivors in America, 3 million are men, and 3.8 million are women.

Stroke is the fifth-leading cause of death for men—and the third-leading cause for women.

For the first time, the American Heart and American Stroke Associations have released a set of stroke guidelines that describe stroke risks specific to women and suggestions on how to address them:

  • Pregnancy’s role: If you are pregnant and have moderately or severely high blood pressure, talk to your doctor about possible medication. Those with a history of high blood pressure should be considered for low-dose aspirin and/or calcium supplements to lower preeclampsia risks. Women who’ve had preeclampsia have twice the risk of stroke and four times the risk of high blood pressure over their lifetimes.
  • Pill risk: Get screened for high blood pressure before taking birth control pills, because high blood pressure, along with the pill, may increase stroke risk.
  • Migraine hazard: Women who have migraine headaches with aura should quit smoking to avoid a higher stroke risk.
  • Don’t skip a beat: If you are older than age 75, get screened for an irregular heartbeat, as there is a link between atrial fibrillation and stroke risk.

Obesity can also increase your stroke risk because of the effects that go along with it, such as an elevated blood sugar, high blood pressure, and high cholesterol, which can add up to the metabolic syndrome.

These new guidelines don’t rule out existing recommendations given to both men and women: Manage your blood pressure and cholesterol, as well as issues like heart conditions or diabetes. Lifestyle choices remain important—exercising at least 30 minutes a day, eating healthy foods, avoiding excessive alcohol and quitting smoking.

And, even if you have one or more of these newly defined risk factors in your life, it doesn’t mean agonizing. If you have any one of them, it doesn’t mean you’re going to have a stroke, but when combined with other risk factors, it’s something you should discuss with your primary care provider.

The OHSU Stroke Center provides advanced stroke prevention care as well as the highest levels of acute stroke treatment. OHSU has received certification as a Comprehensive Stroke Center, the first such center in the Pacific Northwest.

Order your FREE stroke prevention packet here.

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Helmi Lutsep. M.D.
Vice Chair and Dixon Term Professor of Neurology

Dr. Lutsep completed her medical degree and neurology residency at the Mayo Clinic. She pursued fellowships in behavioral neurology at the University of California, Davis and in cerebrovascular disease at Stanford University. Her clinical area of focus is stroke prevention and acute stroke treatment. 

 

Teenagers must understand their own brain — a work in progress

The adolescent brain is a work in progress. The teenage years entail immense responsibility. At 15, many face a rigorous course load of honors classes. At 16, a teen can legally getbehind the wheel of a car, and at 17 many are nearing full independence — sometimes abusing this independence with decisions like unhealthy diet, lack of sleep, and binge drinking.

Yet, even as teenagers take on the daunting task of adulthood at age 18, their brains are still years from being fully developed. Without the information about this critical time of brain development, some students are destroying the brain cells they will need for the rest of their lives and threatening the long-term health of their brain. Sadly, while some teenagers are behaving in ways that may ultimately catalyze severe mental health disorders, others endure taunting and teasing from their peers for pre-existing brain-based conditions. This very bullying has been proven to be a major contributor to depression, anxiety and other brain-based conditions, creating a vicious cycle of ignorance, bullying, and distress to the brain.

Over the course of the past year, I’ve encountered these issues by attending various lectures, reading countless books, and watching a multitude of YouTube videos on the adolescent brain. Most had titles along the lines of “What Every Parent Should Know about Their Teen’s Brain” or “How Educators can Better Teach The Adolescent Brain.” In all my research, never once did I stumble upon information designated for teenagers to understand their own brain.

As a 17-year-old student, I felt like an imposter sneaking into seminars clearly directed at an 18 and older audience, where researchers and scientists would inform adults about how they can better understand the psyche of the child, student or rambunctious teenager in their life. However, my sense of isolationism was soon replaced by the realization that I deserved to know what was occurring in my brain and understand the way that my behavior today can change my tomorrow.

As each book came to a close or each lecture moved into its Q & A Session, the only questions I could bring myself to ask were “Why is it that this information about my age group is rarely provided to my age group?” and “How could we close the divide between the scientific community and the teenage community?” I started to contemplate this question: With bullying growing as an epidemic everyday in middle schools and high schools across the nation, don’t teenagers deserve a biological perspective on the brain that is a nonjudgmental way of helping them understand more about themselves and others?

Bobby Heagerty

Together, Bobby Heagerty, director of neuroscience community affairs and education at the Oregon Health & Science University Brain Institute, Kellen Voss, a post-doctoral researcher in OHSU’s Department of Neurology, and I have been working to answer these questions. The outcome has been the launch of a brain awareness campaign and club at my school in Southwest Portland, Riverdale High School. Riverdale prides itself on embracing those who don’t fit the “mold” of the average student, and in turn it attracts students from all ranges of learning capacities and welcomes a host of students with psychiatric disorders, learning disabilities, and general psychological or neurological “quirks.” The Brain Awareness Campaign will work to eliminate the stigma around these quirks, through a two-faceted program that promotes acceptance and education of brain-based disorders.

The first facet of the program is acceptance, which we will achieve by implementing community-building events that are open to everyone, a buddy system that pairs upperclassmen in leadership roles to underclassmen struggling with a neurological impairment, and annual awareness campaigns, such as brain awareness week, mental health month and more.

The second facet, education, will work to mitigate bullying that derives from a widespread ignorance of what each student may be up against. Already, students participating in the Brain Awareness Campaign at Riverdale have spent lunch periods researching the latest breakthroughs in the mental health community and discussing the controversial developments in the treatment of conditions ranging from ADHD to Autism.

In the club’s preliminary meetings, students have dug through the most ground-breaking articles, provided by OHSU’s databases and Portland State University’s library, and discovered fascinating brain and mental health statistics to be written on posters and posted around the school. As students returned to school in the fall, the club has honed in on a different brain-based disorder every month, meeting each week to uncover the latest findings on the condition and discuss how the brain-based disorder emerges and impacts the affected. We will examine how the illness or disorder is being approached by the scientific community, and consider how the treatment of people living with the disorder, both medical and personal, can be optimized.

Adolescence is a time for surging emotions, unruly hormonal behavior and massive changes to the growing brain. In other words, it’s a challenging time for the healthiest brain. In this time of impulsivity, it is comforting to know that there is a rational force behind the tantrums, the breakdowns and the mood swings: science. It is vital that students understand that the boy with the angry disposition may be suffering from the onset of bipolar disorder or that the girl with the quiet demeanor may be clinically depressed. It is imperative that middle school and high school students alike understand that neglecting to eat healthy and exercise, stressing excessively, and abusing drugs and alcohol today could lead to the onset of brain-based disorders tomorrow. They need to understand the importance of adequate sleep in the prevention of serious mental illness.

While many neurological conditions are genetic and cannot be attributed to the actions of the affected, there is much teenagers can do to protect their brain during a critical time of development. You don’t have to be a neuroscientist to know that teenagers don’t listen to adults. The Brain Awareness Club provides an avenue for teenagers to educate teenagers.

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Sophie Hamilton
Senior, Riverdale High School, Portland
Student Advisor, OHSU Brain Institute

 

Health watch: Jogging your memory

In March, researchers conducting a study of older adults announced a blood test that could predict the onset of Alzheimer’s disease. Of course, the test is very preliminary and the testing process, itself, still needs more research.

So, what can you do to know to help stave off memory loss? What do you and your loved ones need to know about dementia?

Alzheimer’s and other forms of dementia often have something in common: they may co-exist with cerebrovascular disease. Cerebrovascular disease includes conditions such as hardened arteries or stroke that may restrict blood flow to the brain, and likely play a prominent role in age-related mental decline.

What can you do to help prevent cognitive decline as you age?

Unlike Alzheimer’s, cerebrovascular disease is preventable. Studies have shown that maintaining a healthy diet, blood pressure and cholesterol levels, and regular exercise early on may help prevent ongoing and sometimes silent damage to your brain that manifests itself later in life. Joggers

Any exercise is helpful, and something as simple as a 30-minute brisk walk three times a week can make a real difference. The most important thing is to get moving when and how you can. Getting older doesn’t necessarily mean getting Alzheimer’s. However, age-related changes in thinking definitely occur.

Those keys you’ve misplaced or an acquaintance’s name that’s escaped you? They can be part of normal aging. As long as it doesn’t interfere with what you need to do day to day, it’s probably fine. When someone has changes in thinking severe enough to affect the ability to do daily activities like taking medication or paying bills, that could be a sign of dementia.

Do a few memory lapses mean you could have dementia?

Forgetfulness shouldn’t mean self-diagnosis. Other health issues–such as vitamin B12 deficiency, thyroid conditions, infections, or depression–can cause similar symptoms.

Who is most at risk for developing Alzheimer’s disease?

Women are at increased risk, primarily because they live longer. Hormones or genetics may also play a part, although this is still being researched.  Alzheimer’s also affects women more in that women often serve as primary caretakers.

We’re doing a number of studies on Alzheimer’s and other types of dementia, for prevention as well as treatment during all stages of the disease. By taking part in Alzheimer’s research, you could help yourself and others. For information about OHSU’s research studies on dementia and healthy brain aging, contact the Layton Aging and Alzheimer’s Disease Center.

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Lisa Silbert, M.D., M.C.R. Dr. Silbert completed her neurology residency at UCLA and fellowship training in both Geriatric Neurology and Clinical Neurophsyiology at OHSU. Her research interests include the effects of subcortical white matter disease on age-related cognitive and motor slowing.

 

Deniz Erten-Lyons, M.D. Dr. Erten-Lyons is Assistant Professor of Neurology at Oregon Health and Science University. Dr. Erten-Lyons’ research focuses on understanding why some individuals age with minimal or no cognitive decline. She is interested in identifying genes which affect brain morphology and function in late life, and the role genetics plays in cognitive reserve.

What you missed at BRAINet: Post-Vietnam aircraft contamination effects on personnel

Fred Berman

Dr. Fred Berman, DVM and Ph.D.

Our Brain Research Awareness and Information Network (BRAINet) is a volunteer outreach organization of the OHSU Brain Institute. Each month, an OHSU clinician or researcher presents a lecture to members on a new brain-related topic. Our goal is to foster awareness and support for neuroscience research.

This September, we had the privilege of hearing from Fred Berman, D.V.M. Ph.D., who heads the Toxicology Information Center  within the Oregon Institute of Occupational Health Sciences at OHSU. ~Julie Branford, President of BRAINet

The focus of Dr. Berman’s lecture centered on the story of Air Force General Wesley Carter, who had shared with Berman the details of airplanes used by the Air Force Reserve after the war in Vietnam. Thirty-four U.S. Air Force MC-123 aircraft, used in Vietnam from 1961-71, had carried herbicides and insecticides used to defoliate the jungles of Vietnam. They were then returned to the United States for the Air Force Reserve to use from 1971-82. Many of the pilots and mechanics who flew the planes in the United States became ill with diseases such as leukemia, non-Hodgkin’s lymphoma and cancers of the larynx, lungs, and prostate.

Berman was then asked to investigate the connection between the planes and the personnel associated with them. What he discovered was that the planes were scrubbed by hand with dish soap after the planes returned to the United States. Nine years after their use in Vietnam, the planes had high levels of the toxins still clinging to the insides of the planes.

MC-123 Aircraft "Patches"

“Patches” came back to the U.S. in 1972, and served in the Air Force Reserve as a C-123K until it was retired to the National Museum of the United States Air Force in 1980. (U.S. Air Force photo)

One such plane, Patches, was finally retired to the U.S. Air Force Museum at Wright-Patterson Air Force Base in Ohio and was deemed so highly contaminated that no one was allowed near it.

Incredibly, many of the U.S. personnel who flew or maintained these planes were denied medical coverage or benefits because they “did not have boots on the ground in Vietnam.” The exposures have been carried through to these men and women’s children and grandchildren.

Post-Vietnam aircraft contamination remains an open issue in Washington D.C. Berman’s paper, “Post-Vietnam Military Herbicide Exposures in UC-123 Agent Orange Spray Aircraft,” recommends that the Department of Defense use honest, unbiased scientific information when determining whether Air Force personnel should receive benefits or not.

Dioxins are still an issue today, even in our day-to-day lives. Toxins from forest fire sprays and in pulp and paper manufacturing make their way into our homes. Other recommendations from Berman:

  • Heat your food in glass containers when using the microwave.
  • Stay away from Bisphenol A — more commonly know as BPA — which can be found in some plastics, certain electronic cash register receipts, and canned food liners.

Interested in learning more about BRAINet or other brain education activities? Visit BRAINet online or email us at orbrains@ohsu.edu for more information.

Finding the end of the story…in different ways

Many years ago, while walking down a sidewalk with my son, I looked down at my small boy and asked him whether he preferred reading fiction or non-fiction. He said he likes what he learns from non-fiction but it isn’t as exciting as fiction. Non-fiction tells you what’s happening right from the start, he said, but in fiction, you don’t find out until the end.

His comment was an epiphany for me. I study mouse social behavior, an area of research useful for understanding autism, addiction and animal communication. I have a Ph.D. in immunology, master’s degrees in behavioral ecology and toxicology, more than 30 scientific publications and I’ve been a professor in behavioral neuroscience at OHSU for nearly seven years.  As a scientist, I often don’t have answers after a year of research, or even after a decade. So, in a sense, I experience science more like a reader of fiction than of non-fiction. Irked by how science is portrayed to the public, I decided to learn how to write creatively, like an author whom non-scientists — normal people — might actually read.

Over the last 10 years, I’ve taken writing classes at the Iowa Summer Writing Festival and worked with a mentor in creative writing. I submitted my first essay, ‘NQR,’ to a writing contest fielded by december magazine. It’s not a well-known magazine, but has featured works early in the careers of some great authors including Joyce Carol Oates, William Stafford, Marvin Bell and Raymond Carver. In this essay, I watch a young boy undergo a clinical evaluation for autism and consider myths about the science process that our society holds dear. ‘NQR’ won the Curt Johnson Prose Award in Creative Nonfiction.

When I write up my scientific studies, my discoveries are behind me. When I write creative essays, I make discoveries while I’m typing. I guess my son knew that too.

Garet Lahvis, Ph.D.
Assistant Professor
Behavioral Neuroscience
OHSU Brain Institute

Here’s an excerpt from Dr. Lahvis’ ‘NQR:’

It’s uncomfortable standing behind the one-way mirror. It extends from the drop ceiling to about chest height, so the gray metal chairs aren’t high enough to view the clinic room. The air tastes stale, marked by a tinge of glue once ladled under the blue-grey carpet. I watch through the mirror, my two graduate students standing beside me.

A six-year-old boy walks through our clinic room door, pauses, then continues toward a few toys scattered by a bin and a squat table near the left wall. I see wooden blocks, a plastic action figure, and a small pillow that looks like a smiling locomotive. He picks up several blocks and brings them to the center of the room. A clinician in her late 20s enters the room followed closely by a man and a woman. She gestures toward two small plastic seats formed like ice cream scoops, perched on thin chrome legs, better fitted for children. The boy’s parents sit down, side-by-side. The clinician sits down on a small chair by the wooden table. Knees high, she writes on the cover of a light blue pamphlet. The boy sits on the red-orange carpet, one leg curled below him, the other extended to shield the blocks.

The clinician reaches toward a blue polyurethane bin, its lid faded under the fluorescent lighting. Scrawled on its surface, as if there were no thought to its semi-permanence, reads, ‘ADOS Kit Complete: Autism Clinic.’ She wades her hand through the bin and draws out a bulky translucent plastic bag, opens it, and lets toys tumble onto the table.

“Jason, I have some toys here . . .”

On the floor, the boy turns a block, cradles it in his fingers and drops it, turns another block, cradles it in his fingers, and places it on the carpet.

An autism diagnosis is nuanced. Clinicians find children as “on the spectrum” if they repeat certain behaviors or thoughts and have difficulties with social interactions and communication. Each child on the spectrum tacks on a different orientation. One boy sways back and forth by the front door.

Read the essay in its entirety here – please note that you’ll be prompted to enter your name and email address in order to gain access.

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