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Thursday, May 5, 2016

Vocational Rehabilitation

In The Politics of Autism, I discuss employment of adults with autism and other developmental disabilities.

A release from the AJ Drexel Autism Institute:
The A.J. Drexel Autism Institute’s latest National Autism Indicators Report found that 60 percent of people with autism who received services from Vocational Rehabilitation left the program with jobs, but a majority earned wages below the federal poverty line.
Last year’s National Autism Indicators Report found that a third of young adults never got work or continued education between high school and their early 20s. Exploring that issue, the 2016 report specifically examined the U.S. Vocational Rehabilitation system, which is the nation’s largest source of public assistance for people with disabilities who seek employment.
“Unemployment is a critical issue facing people on the spectrum who have valuable contributions to make but not enough opportunities to have work,” said Paul Shattuck, PhD, leader of the Life Course Outcomes Research Program in the Institute, which produces the National Autism Indicators Report series. “Anything we can do to understand the support systems that are in place to secure employment for adults with autism will enable us to better assist this population in the future.”

Vocational Rehabilitation is a federally funded program that is administered under the U.S. Department of Education through the states. Its goal is to assist people with disabilities to get and keep jobs. In doing so, it collects data about its services — such as on-the-job supports and job placement — and the outcomes in each state.
Looking at that data, Drexel’s researchers found that the number of people with autism who applied to Vocational Rehabilitation more than doubled between 2009 and 2014, going from 7,428 to 17,753. Of those who were eligible, 68 percent received services.
Ultimately, roughly 60 percent of people with autism had a job when they left the program. Most of those jobs fell into six categories, with office and administrative support being the most common, followed by food preparation/serving and building/grounds cleaning and maintenance.

Jobs held by those when they left the program followed national labor market needs and were in areas with the most projected growth for the next decade.
“We found that over half of the people with autism who used Vocational Rehabilitation services got jobs,” said Anne Roux, lead author of the report and research scientist in Life Course Outcomes at the institute. “While it was the same rate as people with other types of disabilities who used the program, the wages, hours worked and range of job types for people with autism were low — placing them at risk for poverty.”
More than 80 percent of people with autism who left Vocational Rehabilitation with a job worked part time — compared to 19 percent of the general population.
Those who left the program with a part-time job had median weekly earnings of $160. When looking at the federal poverty guidelines for 2014 (the year the salary data was gathered), those with autism who worked part-time earned wages that were below the poverty line — which stood at roughly $224 per week.

The 20 percent of those with autism who left Vocational Rehabilitation with a full-time job earned a median weekly wage of $380.
“Where you live matters,” when it comes to Vocational Rehabilitation, according to the report. Differing policies, legislation and economic elements in each state present unique factors, and the implementation of new federal legislation, theWorkforce Innovation and Opportunity Act (WIOA), will likely provide more variation.

This year’s report looked in-depth at the numbers by state and found differences.
The rate of employment upon leaving Vocational Rehabilitation was highest in Alabama (79 percent) and lowest in New Mexico (29 percent)
Median hourly wages for those with autism who received Vocational Rehabilitation services were compared to workers in each state: Washington D.C. had the highest disparity at $22.95; West Virginia had the lowest at $4.04

The Life Course Outcomes Research Program’s mission is to build a base of knowledge about topics, other than clinical interventions, that promote positive outcomes for people on the autism spectrum, their families and communities. As such, this year’s report on employment will provide another critical step forward in expanding the conversation about what we know — and what we need to know — to improve the quality of life for adults with autism.
“We envision a future in which people on the autism spectrum are valued as contributing members of communities, with roles to play and dreams to pursue,” Roux said. “Each step we take with our research builds knowledge that brings us closer to that goal.”
The full report can be viewed through this link.

Wednesday, May 4, 2016

Diagnostic Migration

In The Politics of Autism, I discuss prevalence and talk of an "autism epidemic."

Jenna Chandler writes at The Orange County Register:
Two Chapman researchers analyzed 15 years of state special education eligibility data and found many students who once would have been considered to have a condition called Specific Learning Disability are now told they have autism.
...
According to the Chapman study, children who were once given the label Specific Learning Disability are now falling under the autism umbrella. Children with SLD don’t have an intellectual impairment, but fall short of expectations on such academic measures as listening, thinking, spelling or mathematical calculations. The shift is a concept the Chapman researchers are calling “diagnostic migration.”
“For every new kid with autism, there’s one less with SLD,” said researcher Donald Cardinal, a professor and former dean of educational studies at Chapman.
“We are showing that the increase is highly likely not a medical explanation. That alone is massive given how much we are spending on medical research,” he said.
Cardinal and Amy-Jane Griffiths, a clinical psychologist and assistant professor, unveiled the findings Tuesday to several hundred parents, service providers and researchers. The study has not yet been published in a scientific journal.
The professors analyzed special education eligibility designations for every student ages 3 to 22 in California schools from 2000 to 2015. To be eligible for special education, students must have a disability that falls into one of 13 categories, including Specific Learning Disability, autism, hearing impairment and traumatic brain injury.
Erika Aguilar reports at KPCC:
Those who work with children with autism say improved diagnosis has helped better tailor academic resources to help them — but those resources are still inadequate as the population ages out of school.

“The more that we can understand their differences and their strengths as well as their similarities we can come up with better interventions,” said Amy Jane Griffiths, co-founder of the Institute and a licensed psychologist.
Griffiths said schools have learned to help autistic children manage their disabilities by trying to improve their social skills and academic performance but those services aren’t as intense once autistic children become young adults.
Although people with autism can be diligent workers, finding a job that harnesses that energy can be difficult; unemployment, underemployment and low pay are often the result.
“They get placed into jobs that they have no interest in. They’re not a passionate about it,” Griffiths said. “So, they don’t maintain the job. They have no motivation to. It’s not exciting.”

Tuesday, May 3, 2016

Emken and Trump


Katherine Krueger reports at TPM:
Donald Trump spokeswoman Elizabeth Emken, a former executive with the leading advocacy group Autism Speaks, was put in a difficult position Monday when asked about the frontrunner’s earlier statements linking vaccines and autism.

Asked on CNN about Trump suggesting a scientific link exists between childhood vaccines and autism during a fall 2015 presidential debate, Emken sidestepped a direct rebuke of Trump’s claims.
“The position of Autism Speaks has been for quite awhile that we need to find out what's happening,” she replied. “We know there's a genetic component and there's an environmental trigger and until we get to the bottom of what's happening, no one knows what causes autism. Anyone that tells you what does or what doesn't cause autism is simply not basing that on facts."
Autism Speaks on vaccines:
Over the last two decades, extensive research has asked whether there is any link between childhood vaccinations and autism. The results of this research are clear: Vaccines do not cause autism.

Monday, May 2, 2016

Studying Wandering

The Politics of Autism discusses the problem of wandering, which is the topic of legislation before Congress.

A release from Northwell Health:
A review of data on 1,420 children ages 6 to 17 with autism spectrum disorders (ASDs) found that more than one-third had wandered away from a safe environment within the past 12 months, according to findings from two studies reported at the Pediatric Academic Societies meeting in Baltimore.
Elopement, or wandering, places children with autism spectrum disorders at risk of serious injury or even death once they are away from adult supervision,” said Andrew Adesman, MD, chief of developmental pediatrics at Cohen Children's Medical Center of New York and senior investigator of the studies. “Despite its clear relevance to the safety of these children, there has been little research on elopement.”
Researchers examined data from a Centers for Disease Control and Prevention survey of parents and guardians of more than 4,000 children ages 6 to 17 diagnosed with ASD, an intellectual disability or developmental delay. For their studies, analysis was restricted to only those children with ASD.

The researchers found that wanderers were more likely to not realize when they are in danger, to have difficulty distinguishing between strangers and familiar people, to show sudden mood changes, to over-react to situations and people, to get angry quickly, and to panic in new situations or if change occurs.
Researchers also found that wanderers were more than twice as likely to elope from a public place, compared to their home or school.
“As the prevalence of autism spectrum disorders in the United States continues to rise, there is a need to better understand the behaviors that may compromise the safety and well-being of these children,” said Bridget Kiely a research assistant in the division of developmental and behavioral pediatrics at CCMC and principal investigator of the study.
These findings also highlight an urgency to identify more effective strategies for preventing potential elopement tragedies.

Sunday, May 1, 2016

Earlier Diagnosis

In The Politics of AutismI discuss screening and diagnosis

A release from the American Academy of Pediatrics:
Researchers say children with autism who were born before the 2007 recommendation by the American Academy of Pediatrics (AAP) that all children be screened for the disorder at the 18- and 24-month well child visits, were diagnosed significantly later than they are today. The findings suggest the policy may help identify children with autism sooner so they can benefit from early intervention.
An abstract of the study, "Age of Diagnosis of Autism Spectrum Disorder in an Ethnically Diverse Population Before and after the 2007 AAP Recommendation for Universal Screening," will be presented at the Pediatric Academic Societies 2016 Meeting on May 1.

Researchers compared two groups of children initially diagnosed with autism spectrum disorder (ASD) between 2003 and 2012 at a university-affiliated developmental center in the Bronx: those born before 2005, a pivotal year because children born then would have been 24 months old when the AAP recommendation was issued, and those born in 2005 or later. They found the average age of diagnosis for those born before 2005 was just under four years old; for those born during or after 2005, it was roughly two-and-a-half years old.

"Our research shows that children evaluated before the AAP recommended universal pediatric screening were more likely to be diagnosed at an older age and with more severe autistic symptoms and more impaired adaptive functioning,"said lead author Maria Valicenti-McDermott, M.D., M.S. an assistant professor of pediatrics at Albert Einstein College of Medicine and an attending physician at the Children's Evaluation and Rehabilitation Center at Montefiore Health System. "This shift has been critical in light of research showing the significant impact early intervention can have for children with ASD," she said.

Dr. Valicenti-McDermott said the significant drop in age of diagnoses affected all ethnic groups, including Latino and African American children. This is important, she said, because demographic factors such as race and ethnicity are linked with later diagnoses, fewer concerns about possible symptoms of autism being expressed by families or asked about by providers, and possible worse overall outcomes.

"Despite data supporting the benefit of earlier therapy for children with autism and ongoing efforts to overcome obstacles to delays in diagnosis, children who are Latino or African-American are still diagnosed later than white children," Dr. Valicenti-McDermott said.

She said additional research is needed to confirm the effectiveness of universal autism screening. Earlier this year, the U.S. Preventive Services Task Force concluded there wasn't enough evidence to recommend universal autism screening of young children when no concerns of autism spectrum disorder have been raised by their parents or clinical provider.

"It remains unclear at this point whether the significant drop in average age of diagnosis we found was entirely the result of pediatrician universal screening or the effect of the national campaign to increase awareness of ASD in general and the importance of an early diagnosis in particular," Dr. Valicenti-McDermott said. "But given the undisputed benefit of early identification of autism, sorting out the contribution of universal screening to this pattern will be an important next step to address the concerns of the U.S. Preventive Services Task Force regarding the benefits of early screening."

Dr. Valicenti-McDermott will present the abstract on Sunday, May 1 at 5:45 p.m. in Exhibit Hall F at the Baltimore Convention Center. Read the abstract.

Saturday, April 30, 2016

"More Questions Than Answers"

In The Politics of Autism, I discuss various ideas about what causes the condition.
Here is just a partial list of correlates, risk factors, and possible causes that have been the subject of serious peer-reviewed studies:
Pesticides;
Air pollution and proximity to freeways;
Maternal thyroid issues;
Autoimmune disorders;
Induced labor;
Preterm birth;
Birth by cesarean section;
Maternal and paternal obesity;
Maternal and paternal age;
Maternal post-traumatic stress disorder;
Smoking during pregnancy;
Antidepressant use during pregnancy. 
Children living in an area of New York state that uses aerial pesticides to control mosquitoes have a higher rate of autism than children in neighboring areas, a new study finds.
Researchers found that children living in a swampy region in central New York were 25 percent more likely to have been diagnosed with autism or general developmental delay, compared to children in other parts of the state.
However, the findings do not prove that aerial pesticides raise the risk of autism, stressed lead researcher Dr. Steven Hicks, a pediatrician at Penn State Milton S. Hershey Medical Center, in Hershey, Pa.
“This study really brings up more questions than answers,” he said. “We need more research before taking any public action on pesticide use.”

Friday, April 29, 2016

Helping Autistic College Students at CUNY

In The Politics of Autism, I discuss the growing number of college students on the spectrum:
We do know that autistic students suffer high levels of depression, anxiety, and social isolation. We also know that their difficulties can affect their academic performance. (Group projects can be hard.) They have to cope with these problems without the protection of an IEP, since the Individuals with Disabilities Education Act does not apply to higher education. The Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act of 1973 provide for certain accommodations (for instance, extra time for tests), but the student has to seek them. According to Jane Brown Thierfeld, co-director of an organization of professionals who assist autistic students, for every student receiving special services, there  are one or two on that same campus who have not come forward.
Meredith Kolodner writes at The Hechinger Report:
Only a few dozen colleges have programs specifically designed to support students with autism, a recent study found. Many of the programs that do exist cost thousands of dollars per semester, on top of tuition. But there are practical and inexpensive methods to help these hundreds of thousands of students navigate the social and academic landmines that stymie them. Failing to help likely consigns them, as adults, to low-wage jobs, dependence on public assistance or ongoing reliance on their parents — who may also be struggling and are unlikely to outlive them.
A pilot program on five campuses at the City University of New York, where the number of students who disclosed that they are on the spectrum has more than doubled since 2012, has shown promising results.
Most CUNY students are low-income, and almost 40 percent come from households with incomes below $20,000 a year. The pilot program was implemented at no cost to students, and, for the most part, students participating in it over the last four years have been more likely to stay enrolled, improve their academic performance (grades for 60 percent of the participants at Kingsborough Community College went up) and report increased satisfaction with their social experience.
Faculty who oversee the program, dubbed Project REACH, emphasize that because of the vast differences in the behaviors and abilities of people on the spectrum, there is no one-size-fits-all solution. But the program is built around a combination that works: weekly workshops (which are open to all students with disabilities) and one-on-one peer mentorship seem to meet a lot of students’ needs.