The research on boredom as described by James Danckert in “Chronic Boredom May Be a Sign of Poor Health” is interesting in a number of ways, but it also shows that there are limitations to research that concentrates on a single emotion. Instead emotions should be viewed as parts of a more general system of experience. For example, one model called reversal theory posits that boredom can only be fully understood as one of a set of four related emotions: boredom, excitement, relaxation and anxiety.

These four emotions differ on two dimensions: whether high or low arousal is desired and what level of arousal is actually being experienced. Boredom occurs when the desire is for high arousal, but it is low arousal that is actually experienced. In contrast, relaxation is the desire for low arousal when arousal actually is low; excitement is the desire for high arousal in the presence of high arousal; and anxiety is the desire for low arousal in the presence of high arousal.

Whether a given level of arousal is pleasant or unpleasant, therefore, depends on what we might call motivational state. By studying these emotions related to levels of arousal, as well as other sets of emotions and motivational states, reversal theory pursues questions such as what brings about reversals among different motivational states and how people respond to these internal changes.

Danckert reflects on the lack of definition regarding boredom; reversal theory, however, clearly defines boredom in psychological terms and how it relates to arousal and state of mind.

Mitzi Desselles
Louisiana Tech University Ruston, La.

In the article “How Your Eyes Search a Scene,” Michael C. Hout and Stephen D. Goldinger suggest that baggage screeners looking for weapons may make errors because they do not expect to find any weapons. It seems more likely to me that the making of errors would be because of agitated boredom, as described in “Chronic Boredom May Be a Sign of Poor Health,” by James Danckert. The finding of a weapon would probably be very extrinsically stimulating to a baggage screener. After screening hundreds (or thousands) of pieces of baggage and not finding any weapons, agitated boredom would undoubtedly arise because of the lack of external stimulation, and mistakes would tend to occur because of the boredom. One way these two effects might be dissociated might be to monitor the occurrence of mistakes over a longer term. If the mistakes are more or less uniform over a given period, then low expectation may be at work. If the mistakes increase over time, then agitated boredom may be at work.

Richard Sieb
Edmonton, Alberta

As a child psychologist who has diagnosed and worked with many children and adults with autism for many years, I have never encountered a case where a child properly diagnosed with autism has “recovered,” as Jennifer Richler describes in “Is It Possible to Recover from Autism?” [Perspectives]. Rather I have observed cases where a person, usually high functioning, has memorized responses that give the impression of social engagement when it is not present.

The problem is rooted in misdiagnosis. I have found the rate of falsely diagnosed autism to be upward of 30 to 40 percent—even higher for Asperger's. In some cases, very young children are diagnosed when they respond to the pressure of testing by exhibiting behaviors that are mistakenly attributed to autism, such as hand flapping. Some of these children may be identified as having a different developmental disorder by the time they enter kindergarten, but the inaccurate label of autism remains.

There is huge motivation for gain: children with autism receive very high levels of service. Caregivers have been taught to believe that 40 hours a week of specially designed therapies such as Discrete Trial Training, a one-on-one learning method with instructor feedback at every step, are required to help children recover from, in my opinion, a condition they never had.

Even more telling was the comment I heard made by the editor of the diagnostic guide DSM-IV, who expressed regrets on National Public Radio for including the category of Asperger's. He said, to paraphrase, that to get services for children who “looked odd,” schools and mental health providers used the diagnosis of Asperger's. Yet that condition, according to this editor, has a “diminishingly small frequency of occurrence.”

David Herman
Elkins Park, Pa.

RICHLER REPLIES: Misdiagnosis is indeed a problem in some purported cases of autism. In both studies I described in the article, however, the diagnosticians were highly trained and experienced. The researchers in the retrospective study used a rigorous review process to minimize the chance of initial misdiagnosis.

The other study was longitudinal; the same experts who did the initial diagnosis were the ones who followed the participants over time. In both studies, the experienced diagnosticians should have been able to recognize subtle signs of autism, even in someone who had “memorized responses that give the impression of social engagement when it is not present.”

Your autism article was fascinating reading. When my son was diagnosed 15 years ago at age three, we were told categorically by the doctor that autism is a lifelong, untreatable condition. Fortunately, we chose not to accept that, and now he is very largely recovered, although with a few remaining issues connected to socialization.

Alongside behavioral training in his early years, we believe that his gluten- and dairy-free diet has a lot to do with his recovery, a possibility not mentioned in your article. We often wonder why trying the diet for six months is not recommended to all parents as a possible if not guaranteed route to recovery. Perhaps it has to do with experts' reluctance to admit that at least some of what discredited physician Andrew Wakefield has said about autism being linked to gut function is right after all!

Paul Hemphill
Newcastle upon Tyne, England

RICHLER REPLIES: Although there are anecdotal reports of improvement in the symptoms of autism spectrum disorder following the introduction of a gluten-free, casein-free diet, to my knowledge there is no high-quality research (that is, double-blind, randomized controlled trials) that supports these claims. I would imagine most responsible doctors and other professionals are reluctant to recommend any kind of special diet in the absence of such evidence.

Justin Rhodes asserts in the column Ask the Brains that “part of the reason exercise enhances cognition has to do with blood flow…. More blood means more energy and oxygen, which makes our brain perform better.” This phrasing implies that the brain performs suboptimally until the heart pumps more vigorously, akin to a car engine awaiting the flooring of the accelerator pedal to deliver more gas.

A different article in the same issue, “Can Caresses Protect the Brain from Stroke?” by Stephani Sutherland, provides the better conceptualization: “the brain's vasculature might be at the beck and call of the very neurons it serves.” I would add that, in fact, the beautiful pictures from functional MRI scans are possible because neurons actively regulate essentially all brain blood flow.

Thus, neurons are not passively awaiting the surge of oxygenated blood associated with the “blood flow increase everywhere in the body” from exercise. Rather neurons activate the muscles engaging in exercise and regulate both systemic circulation and brain microcirculation to ensure that the metabolic needs of their own increased activity are met.

Michael J. Soso

Because of an editing error, in Robert Epstein's review of Gary Greenberg's The Book of Woe [Reviews and Recommendations, September/October 2013], the publisher of the Diagnostic and Statistical Manual is incorrectly printed as the American Psychological Association. The publisher of the DSM is the American Psychiatric Association. Also, the review of Melody Moezzi's Haldol and Hyacinths in the same issue misstated the author's homeland: it is Iran. We regret the errors.