Leading on from my previous post on dyslexia, this week I’d like to discuss another lesser known learning disability that can be co-morbid with autism- dyscalculia.
So what exactly is dyscalculia?
Dyscalculia is a specific type of learning disability characterized by a difficulty with numbers and arithmetic i.e, understanding how to do maths and manipulate numbers (that’s right- not all autists are good with numbers Hollywood 😛 ) . There are varying levels of dyscalculia but signs may include difficulties with numbers and mathematical symbols, pattern recognition, sequence issues, handling money, managing and telling time, visual processing, and memory issues.
So what causes dyscalculia?
Again as with most aspects of the spectrum, the exact mechanism is unclear. Thought to be related to ADHD, dyslexia and dyspraxia, dyscalculia seems to result from dysfunction in the intraparietal sulcus (an area thought to be involved in processing symbolic and numerical information) and the frontal lobe of the brain. The frontal lobe in particular contains most of the dopamine neurons of the brain which are involved in attention, planning and short term memory- all of which are important functions in comprehending numbers. As discussed in many previous posts, dopamine levels are dysregulated in the autistic brain which could explain why autists may be more prone to these types of learning disabilities.
Is there anything that can be done to help manage it?
As with most disabilities, early detection and intervention are key to helping those with dyscalculia cope with their struggles. There have been very few targeted programs specific to dyscalculia but in recent years a number of digital programs have been created to help improve basic numerical abilities. The gold standard one to one tutoring is also a useful option to help improve these skills through repetition and targeting areas of particular difficulty. Interestingly, there was a study conducted in 2014 where electrical stimulation of the left side of the posterior parietal lobe of the brain (an area involved in spatial reasoning and planned movements) improved numerical abilities in patients. As many as 43% of autists may have abnormalities in their parietal lobe, so further research into this region could provide us with new ways to manage dyscalculia in the future.
This week I’d like to talk about a condition that impacts approximately half of autists- Irlen syndrome.
So what exactly is Irlen syndrome?
First defined in the 1980’s, Irlen syndrome (also known as scotopic sensitivity syndrome (SSS) or Meares–Irlen syndrome) is described as a difficulty in the brain’s ability to process images/visual information. It is not exclusive to autists as it also impacts roughly 15% of the neurotypical population. As 70% of the information we process is visual, the inability to process this information can have a serious knock on effect on our brains ability to function effectively, causing issues with reading, coordination, sensory processing, spatial awareness, and ADHD– all co-morbid issues associated with autism.
But what causes it?
Irlen syndrome is caused by hypersensitivity to certain wave lengths of light which can cause the brain to process visual information incorrectly. The exact mechanism is poorly understood, but the brain seemingly becomes overactive in response to light causing dysfunction. Interestingly, Irlen syndrome is classified as a pseudo-medical diagnosis as there is skepticism over it’s existence as a stand alone condition with a distinct pathology. Experts are skeptical of Irlen syndrome as there is a lot of overlap in symptoms from other conditions and they may be lumped in under one convenient heading.
But is there anything we can do to manage symptoms?
The Irlen method is the main treatment approach for the condition. Pioneered by Helen Irlen, the Irlen method is a non-invasive approach using coloured lenses to filter light and to improve the brains ability to process visual information. The lenses can be either worn as glasses or in contact form.
You can see the impact that Irlen lenses have on the brain here:
However, the efficacy of this method has been difficult to prove. In particular there seems to be little evidence to support their use to improve reading issues and dyslexia. That being said, many people have found great relief from using Irlen lenses, such as actor Paddy Considine who has both Asperger’s syndrome and Irlen syndrome.
As with all pseudoscience/pseudomedicine, take everything with a pinch of salt, but if you think Irlen lenses may help your issues with light sensitivity it’s worth a try!
This week I’d like to discuss my previous experiences with silent discos during my college days and how this phenomenon can benefit autists.
So what exactly is a silent disco?
A silent disco is pretty much what it sounds like- it’s a disco where no music is played through the speakers, but everyone is however provided with a set of wireless headphones to listen and dance to music. Each set of headphones has it’s own volume controls and allows you to pick from up to 3 different channels from different DJs to choose which music genre you would like to listen to- so while everyone else might be raving to EDM, you can rock out in peace. The idea originated in the UK in the early 2000’s and has since taken the world by storm, proving particularly popular with students and leading to more inclusive club nights.
So how can silent discos benefit autists?
One of the major drawbacks of the club scene for autists is the obscenely loud music blaring from the speakers. Sound sensitivity can be a serious issue for autists and will often deter us from dipping our toes into the night time social scene. Silent discos remove this barrier as there are no speakers, you can control the volume of the music (even turn if off if you wish to dance with no music- no one else will know!), control the channel, and if you want to chat to your friends you can simply slip them off and talk at a normal decibel without the need for shouting (bonus- no morning after voice loss!). Silent discos were highlighted in particular in the first season of Atypical to allow Sam to attend a school dance with his classmates in comfort. Light sensitivity from strobe lights can still be an issue, but I’ve always found that sunglasses in clubs can be quite beneficial (some may think you’re a bit odd, but most will think it’s awesome!).
I tried out silent discos in Dublin while I was studying for my masters several years back and found the experience quite refreshing. Over the years I have conditioned myself to the cacophony of club nights (I’ve always had more issues with sudden volume increases rather than general high volume levels- I am quite partial to rock concerts!), but being able to attend a silent disco where I could slip my headphones down and have an actual conversation with my friends between dances was a dream! I was in total control of my headphones and we could all dance together just like any other club night with our eardrums still intact!
Silent discos are a great way for autists to get out and experience college nightlife with a fraction of the stress, so I would highly recommend them for young adult autists trying to settle into the college social scene. Many colleges run silent discos so just watch out for an event near you and give it a try! 🙂
Leading on from a previous post about non-verbal autism, this week I’d like to discuss a popular communication method for non-verbal autists- the rapid prompting method or RPM for short.
So what exactly is RPM?
RPM, also known as ‘spelling to communicate’ is a communication technique that allows non-verbal autists to communicate through a system of writing, typing, or pointing at a letter board.
You can see a video of RPM in practice here:
But is it effective?
Now this is where things get interesting. As far as the scientific community is concerned, RPM is pseudoscience- they can’t generate evidence to prove that it really works. There are concerns that the facilitator of the method may unconsciously prompt and influence an autists answers in the way they move the communication device, and as such, many in the community discourage the practice of RPM until the efficacy and safety can be established.
That being said however, there are so many positive stories out there about how life changing RPM has been for non-verbal autists.
Here in Ireland there was a recent documentary on RTÉ called ‘Speechless‘ about how RPM has completely changed life for non-verbal autist Fiacre Ryan. The documentary followed Fiacre and his family over an eight year period, showing his journey with RPM and how it has enabled him to communicate with his family and give them an insight into his world- as his sister described it, it was like getting to know a completely new person. After discovering RPM, Fiacre went from having only basic playschool level knowledge to a wealth of vocabulary and an aptitude for calculus. With the help of an aide to facilitate RPM, he was able to attend mainstream school. Fiacre went on to be the first non-verbal student to sit the Leaving Certificate exam using RPM (passing with flying colours!), and is currently working with a publisher to create a book of his poetry! 😀 Before RPM, Fiacre says that his mind was very cloudy and dark, but communication has given him a new lease of life.
Leading on from my previous post about managing autism while travelling, after a recent mishap with a suitcase in the airport on my way to Italy, this week I’d like to talk about when things go wrong.
Ordinarily, travelling on my own through an airport is no great hassle for me. I’ve done it loads of times before with no issue, however, with all the disruptions to travel since the start of the pandemic, flying has become a little bit more stressful. Due to reduced capacities on public transport, I started out my journey on the wrong foot by driving the 2 hours to Dublin up a very busy motorway on a Friday afternoon- not the most calming of scenarios given some of the issues autists can have driving. Arriving in the terminal after a lengthy search for a free parking space (despite pre-booking), I made my way directly to bag drop off to relieve myself of the ginormous suitcase I was carrying, laden with goodies from home for an overseas relative.
That’s when things started to go awry…
The suitcase wobbled and rolled off of the self service scales as it was recording the weight, so the label the machine printed off displayed an incorrect value. I proceeded to put the bag on the drop off conveyor… buuuttt it wouldn’t take my suitcase! Now as we are in Covid times, there were crowds of people round me travelling, but not a lot of staff to ask for help from at these desks in order to reduce interactions. So I tried to re-weigh and reprint my tag a second time to find that my bag was 0.8 kg over the limit, leading me to frantically kneel down in the middle of the floor, pulling out shoes and baked goods to shove them in my carry on. I was enduring this stress while still wearing my coat and a face mask, so the heat from the situation was rising, not to mention I was still coming down from the stressful drive, was tired, hungry, and in need of the bathroom- so my sanity was hanging on by a thread! Once I had reduced my weight sufficiently, the machine then refused to print another label for my luggage, and tried to charge me €60 for the pleasure! 🙈
Sooo I frantically searched for a an attendant to advise me, who did not have a solution only that I join the massive queue at the ticket desk…aannnnd then the meltdown hit! Thankfully it wasn’t more than a few tears, and once I communicated that I was autistic to the attendant, she was very nice and supportive 🙂
But the saga wasn’t quite over yet! As I proceeded towards the ticket desk for assistance, another attendant saw me and asked where I was going with my suitcase (as the desk was in the opposite direction to the drop off). I communicated my issue and this no-nonsense lady firmly told me to stop crying! Believe me, I wouldn’t be crying in my thirties over something so stupid as an overweight suitcase if I had the choice 😛 She eventually steered me direct to the drop off and fired the suitcase on the conveyor with a final parting order to stop crying. Five minutes later, I was sitting calmly in McDonald’s, my crisis was over and the mortification set in 😳
Granted, this experience was resolved quickly and could have been a lot worse (I’ve had a 24 hour delay on a previous family holiday), but it was still an extremely stressful few minutes!
Based on this mortifying experience, here are some modified tips for dealing with autism while travelling when it’s too late for prevention:
Take a moment to collect yourself– if you feel like a meltdown could be coming on, take a step back. My stress over increased airport traffic with international travel opening up pushed me to keep going, but I should have paused to take off my coat, grab a snack from my bag, and try the suitcase again.
Take a break in a sensory friendly room (if available)– Irish airports have pioneered sensory friendly rooms for travelling autists to enable you to take some chill time to come down from stressful scenarios. If a space like this is available, take some time out.
Approach a member of stafffor help– if you feel that you are struggling and are in a position to communicate your struggles, reach out to a member of airport staff and they should be able to help make your journey a little easier. Dublin Airport, among others, has a special lanyard that you can get to alert staff that you are autistic if you are in need of assistance, so the training is there for staff to help you in your time of need.
Take a break from your face mask– face masks can be quite problematic for a lot of autists, but are a requirement for travel at present. If you’re getting overwhelmed from wearing the mask for too long, go to the bathroom for a few minutes to pull down your mask and take some deep breaths privately. Pro tip– spend as long as you can in the food court as you will not be required to wear your mask in this area.
Bonus tip– If you’re using a self service scale, place your bag on it’s side, not on it’s wheels- learn from my mistakes 😛 😉
Perhaps the best tip I can offer is to make use of autism assistance programs where available. I have not previously used this service as I have not needed it, and also because other airports like Shannon Airport advocate the use of bright orange hats to quickly identify an autist, which as an adult, this concept would make me feel like a bit of a sore thumb 😛 Check out if the airport you are going to has an assistance program for autists that you can avail of so that in the event that something does go wrong, you will be taken care of. Once I was able to communicate that I was autistic, the staff were happy to help, but other autists may not be able to communicate this mid-meltdown, so make sure to check out assistance programs ahead of time to ensure that the help is available to you in the event that things go wrong 🙂
Leading on from my previous post about sound sensitivity, this week I’d like to explore the subject of noise reducing earplugs. In recent weeks, I’ve been getting a lot of Facebook ad’s for noise reduction earplugs, so I finally decided to take the plunge and buy a pair to see what all the fuss is about.
So how exactly do these noise reduction earplugs work? Isn’t the whole function of earplugs to reduce noise anyway?
Noise reducing earplugs are different to your garden variety earplug in that they are designed to reduce background noise without compromising audio quality in your immediate surroundings. Most earplugs will muffle sounds, but this next generation of earplugs focus on filtering them instead of blocking them. There are a lot of different models out there at the mo, but I chose to test drive Loop Earplugs. Loop are designed with an acoustic channel in the earplug to mimic the auditory canal in your ear, and use a mesh filter to reduce the volume of your surroundings. They are particularly designed with concerts in mind, as music is often played above safe levels (85 decibels) which can permanently damage eardrums in as little as 15 minutes. They have a couple of audio reduction levels from as high as 27 decibels down to 18 (which I tried) so you can purchase whatever reduction level suits your needs.
So how did I find them?
This weekend, I tested them out on a busy day in the noisy city of Dublin. I popped them in while walking down the street and found it really did reduce the sounds around me, but I could still hear everything I needed to, such as the noises from pedestrian crossings. As I was attending a musical, I also gave them a test run in the theatre for a couple of songs. I was really surprised at the results as the songs were just as clear with the earplugs in and out, just different volume thresholds. Unlike other earplugs, the loop in the plug is quite cool, and looks like a trendy piercing in your ear, so it’s also great that you don’t feel self conscious for having awkward things sticking out of your ears (like those ugly yellow foamy ones they give you on airplanes).
However, while these filtered out a lot of background noise, they did amplify and alter some internal noises. My voice sounded really distant and far away like I was down a tunnel, but everyone around me sounded fine. While walking to the theatre I ate a Magnum ice cream, and as I ate, the earplugs increased the volume of the chocolate crunching in my mouth to unsettling levels, and I could hear my jaw clicking as the upper and lower jaws rubbed against each other. It really weirded me out so I would not recommend eating while wearing them! I also found they didn’t sit in my ear that well and kept popping out, but I do have smaller ears (or so I’m told) so it’s possible that my ears are just not built for earplugs! 😛
I would definitely recommend trying out these earplugs or similar models (there are some that are more geared specifically for noise sensitivities such as Calmer) if you need to turn the volume of your surroundings down a smidge- I will certainly be adding mine to my handbag for days when I find myself in an auditory nightmare.
Leading on from my previous post about autism and food, this week I’d like to focus specifically on diet and autism. There are a lot of articles floating around about the benefits of certain diets to manage autistic symptoms, but the research is tenuous and in some cases non-existent.
Ketogenic Diet: This is a high-fat, low-carb, adequate-protein diet that drives the body to burn fats faster than carbohydrates and is recommended in the treatment of some forms of epilepsy in children. Research has shown that in some cases, a modified version of the ketogenic diet led to improvement in repetitive behaviours and social communication in autists. The diet is thought to work by increasing the number of ketones in the brain (an energy source produced from fat breakdown when insulin levels are too low to convert glucose to energy) to produce more energy and offset biological stress and dysfunction in mitochondria (the energy producing cells of the body) which contributes to autistic behaviours.
Sugar-Free/Additive- Free Diets: It’s common knowledge that sugar can alter a child’s behaviour, but even more so for autists (there was a limit put on my childhood coke consumption to curb my hyperactivity for example 😛 ). It’s also thought that many autists are unable to tolerate a number of food additives such as aspartame, MSG and E-numbers. On a personal level, this one actually makes a lot of sense as I have had allergic reactions to certain E-numbers that have caused me to break out in hives in the past (not to mention how they used to make me super hyper!). While indeed lot’s of people reduce sugars and E-number’s to manage childhood behaviours, there’s little research on how sugars and additives impact autists.
Supplements: As it’s thought that autists may have impaired or abnormal biochemical and metabolic processes, vitamin supplementation could be used to improve this. While supplements can be beneficial, the research is inconclusive.
Gluten/Casein -Free Diet (GFCF): This is the most popular diet when it comes to autism treatment. Many people report improvements in autistic symptoms following the removal of gluten (a protein found in grains like wheat) and casein (a protein found in dairy) in their diet. It has been suggested that autists have a “leaky” gut that allows gluten and casein to leak into the bloodstream having an opioid effect on the brain and interfering with behaviours, but there is insufficient and inconclusive scientific evidence to support this. Many doctors have recently spoken out against these fad diets as they can be very bad for your health if you unnecessarily remove these foodstuffs. Gluten free diets for example can increase your risk of cardiac problems through decreased intake of essential wholegrain.
Cholesterol: Cholesterol is involved in modulating the oxytocin receptor and the serotonin 1-A receptor- neurotransmitters that are dysregulated in the autistic brain. Cholesterol deficits could interfere with the functioning of these receptors and contribute to autistic symptoms. Research has shown that cholesterol supplementation can help improve behaviours. I will explore this in more detail in a later post.
Phenols and Salicylates Exclusion: Some studies indicate that autistic behaviours could stem from impairment of certain enzymes involved in the metabolism of phenols and salicylates- antioxidants that are found in fruits, vegetables and nuts. While these compounds are healthy, in high levels these seem to increase levels of serotonin in the brain interfering with autistic behaviours, but there is no evidence to suggest that total avoidance of these compounds is beneficial.
Probiotics and Enzymes: There is currently no research to prove the benefits for probiotics and enzymes in the management of autism. However, as I have discussed above and in previous posts, autists are deficient in certain enzymes and bacteria which can interfere with behaviours, so supplementation could be useful.
Yeast Free Diets: As discussed in my previous post about thrush and autism, candida overgrowth in the gut is thought to contribute to autistic behaviours. The theory posits that removal of yeasts from the diet can improve behaviours, but there is no medical basis for improvement.
Fish Oils and Fatty Acids: Imbalances in omega-3’s and essential fatty acids has been implicated in a number of neurodevelopmental disorders and behavioural issues, so it stands to reason that supplementation could improve autistic symptoms. However, there is much more autism specific research required to confirm these benefits.
Continuing on from last week’s post about autism and puberty, this week I’d like to talk about autism and periods. I know, I’m about to alienate about half of my readers (sorry guys!), but this is a very important topic to cover for the often overlooked autistic female demographic.
Periods can be challenging for lot’s of women, however, for autists the experience can be somewhat of an ordeal. There can be a lot of overwhelming sensory issues where periods are concerned- new smells, sensations, and sensory issues related to the use of feminine hygiene products. Autists struggle greatly with change, and periods can be quite unpredictable over the course of our lives due to stress, hormonal changes, childbirth and eventually menopause (which I will discuss in a separate post at a later stage). As a result of this, female autists can develop a number of behavioural issues related to menstruation such as increased aggression and repetitive behaviours, not to mention changes in mood and mental health. Throw in a side of cramps and it’s no picnic!
In addition to the mental and behavioural toll, research has shown that periods are biologically much tougher on the autistic body. Studies have shown that women on the spectrum have higher levels of testosterone than their neurotypical peers (likely caused by dysfunction in the hypothalamus in the brain), leading to a number of menstrual related issues such as severe acne, hirsutism, irregular periods, polycystic ovary syndrome and dysmenorrhea. Premenstrual syndrome (PMS) is also highly prevalent in autistic women. Autists are also known to have high levels of inflammation in the body, which can further aggravate menstrual symptoms. Periods can even cause an increase in seizures in autists who also suffer from epilepsy due to hormonal fluctuations.
So what can you do to help a young autist through her period?
Educate them clearly about their changing bodies– autistic women can be particularly vulnerable, so they need to know exactly how their reproductive system works and the importance of consent. Use clear language that can not be misinterpreted or taken too literally. Understanding their body will also help them to better normalize menstruation so it is far less scary. As discussed in my last post, autistic women enter puberty much earlier than their peers, so it is essential that they are educated sooner rather than later about their changing bodies.
Check out autism friendly books about puberty/periods– there are a number of books available targeted at growing autists to help them navigate this challenging time. There are even books specifically about periods for young autistic women that may help.
Chat about different feminine hygiene options– as no two autists are the same, so no one option is better or worse when it comes to feminine hygiene products. There are far more options available these days to young women than just sanitary towels and tampons- they even make absorbent period underwear which could be very helpful for girls with sensory issues.
Setup a calendar/diary to track periods- the unpredictable nature of life and unexpected change can be particularly frustrating for autists. While periods can oftentimes be unpredictable and don’t always run on time, a calendar can nevertheless be very helpful to prepare an autist for upcoming periods and establish a routine. Knowing that an event is approaching can help to offset the scariness of it.
Break the taboo– reassure them that periods are a normal part of life and that there is nothing to be ashamed of. Periods may be overwhelming for autists, but they are by no means alone in their menstrual struggles.
Hope my female Earthlings at least enjoyed this week’s post! 😉
This week I’d like to talk about a frequently sidelined aspect of life on the spectrum- puberty. So often people focus on childhood autism we forget that autistic children will grow up and go through puberty just like everyone else.
Puberty is a challenging time for everyone, but often even more so for those on the autistic spectrum. Research is limited on pubescent autists, but some studies have suggested that behaviours can worsen in autists during this time, in particular, aggressive behaviours. The smallest of changes to routine can trigger meltdown’s in an autist, so imagine how this response is amplified when your entire body decides to change. You couldn’t pay me to go through puberty again- the raging hormones were a minefield (although there are day’s during this pandemic where I might consider it to travel back to a time when I had freedom 😛 )!
There can be a lot of sensory issues arising from the onset of puberty that can trigger further distress- body odours, sensory reactions to hygiene products, and my own personal hell, the sensory discomfort from wearing a bra. As I’ve discussed in previous posts, I went to war for years with my mother against wearing one as the sensation of it against my skin freaked me out and I was incredibly uncomfortable- but as I was un-diagnosed, this was passed off as just being awkward 😛
During puberty, socialising, an already challenging task for autists, becomes even more complicated. When you’re a child, everything is easier as kids haven’t developed a filter yet, but once those hormones kick in, conversations become more nuanced, boys and girls interact differently and your peers start to become aware of your mind blindness and excentricities. It can be quite a socially lonely time for autists.
So how can we navigate this difficult time in an autist’s life?
Talk openly about the facts of life– Talk them through the changes their body will experience in clear, concrete language. Don’t leave any room for confusion or misinterpretation so that they will be fully prepared and less thrown by the changes to come- there were certainly a few books that I read growing up where overly simplified language such as “a special hug” was used to describe sex that would only confuse and misinform the more literal autist
An important thing to know about puberty and autism is that it can have a much earlier onset in girls. Studies have shown that female autists tend to enter puberty and start menstruation on average 9 and a half months earlier than their peers, so girls need to be prepared and educated about the facts of life earlier than you might expect
Use visual tools– Sometimes words are not enough to create the correct mental picture for an autist. Illustrated books about puberty can be very useful here, and there are now many books specifically targeted at autists which can really help them to navigate this time
Discuss appropriate/inappropriate behaviours– don’t leave it at just the facts themselves. Autists will need to be taught about consent, sexual behaviours and inappropriate conversational topics just like anyone else. As female autists often mask their behaviours, it is especially important that they are taught about these things as they can be quite innocent and may be taken advantage of if not adequately prepared for adulthood
Sensory friendly clothing– For the young women out there, the market is now opening up to produce sensory friendly bras to help combat the issues of traditional brassieres. Bralette’s and lightweight sports bras may also be helpful alternatives
Normalise the experience– Reassure them that everyone goes through this, that it’s a normal part of growing up. Don’t attribute the entire experience to their autism
Be positive– Don’t assume things will be harder for your child as everyone is different. A positive attitude can go a long way to easing your child into the murky depths ahead
Leading on from my previous post about autism and CBD, this week I’d like to explore another drug that is being researched in the treatment of autism- MDMA, the active ingredient in Ecstasy.
Yes, you’ve heard me correctly, the psychoactive drug MDMA is indeed being explored as a treatment option for autists!
So how can a recreational party drug help people with autism?
First synthesized for use in psychotherapy by Merck in the 1910’s, MDMA is the active ingredient in the street drug ecstasy and is thought to improve anxiety, sensory perception and sociability in those who take it. Many autists who have taken the drug recreationally have reported feeling more at ease in their body and increased empathy.
So how does the drug work?
MDMA increases release of neurotransmitters such as serotonin, noradrenaline and dopamine in the brain- neurotransmitters that are dysregulated in the autistic brain. In addition, MDMA is also thought to boost the hormones oxytocin and vasopressin the body which are also implicated in autistic symptoms. These hormones and neurotransmitters are heavily involved in anxiety and social behaviours, so targeting these makes pharmacological sense for autists.
That’s fine in theory, but does it work?
A pilot study (a small scale preliminary study) was conducted in 2016 to compare the impact of MDMA assisted psychotherapy on anxiety levels in autists versus psychotherapy alone. The study found that social anxiety significantly reduced in the group that received MDMA, a positive change that occurred rapidly and show signs of long term duration. This was however only a small pilot study and studies are ongoing with larger cohorts.
The drug does not currently have any legally approved medical uses, but if these clinical trials prove successful, this may change in the coming years.
In case you’re getting worried, the street drug itself is not being explored- ecstasy does not contain enough MDMA for therapeutic benefit, and it is often combined with other substances such as methamphetamine which make long-term use highly addictive and damaging to overall health. However, long-term use of MDMA does hold similar safety caveats such as sleep disturbances, depression, heart disease, decreased cognitive functioning and concentration so further research is required.