Search This Blog

Saturday, March 25, 2017

Iowa Passes Insurance Mandate

The Politics of Autism includes an extensive discussion of insurance legislation in the states.

William Petroski reports at The Des Moines Register:
The Iowa Senate voted 48-0 Thursday to require many employer-provided health insurance policies to provide coverage for treatment of autism spectrum disorder for young people 
House File 215 was sent to Gov. Terry Branstad for his consideration. Both Republican and Democratic lawmakers praised the bill's final passage, saying it represents years of work by advocates for people with autism. 
Sen. Bill Anderson, R-Pierson, the bill's floor manager, said the legislation will apply to employers of more than 50 full-time workers. It will require coverage of applied behavioral analysis for persons under age 19 diagnosed with autism spectrum disorder. The bill provides maximum annual benefits, depending upon a person's age. Coverage can also be subject to deductibles, co-payments or co-insurance provisions.

Friday, March 24, 2017

How Autism Is Reshaping Special Education


A release at Education Views:
How Autism Is Reshaping Special Education: The Unbundling of IDEA by Mark K. Claypool and John M. McLaughlin will be released on March 28, 2017. Published by Rowman and Littlefield, How Autism is Reshaping Special Education will be released in trade paper (ISBN: 978-1-4758-3497-0 • $25.00 ) hardcover (ISBN: 978-1-4758-3496-3 • $50.00) and eBook editions (ISBN: 978-1-4758-3498-7 • $24.99).
In their latest book, How Autism Is Reshaping Special Education, recognized thought-leaders Mark K. Claypool and John M. McLaughlin deliver a timely, thoughtful, and thought-provoking look at one of the fundamental components of public schooling—special education and its foundational law, the Individuals with Disabilities Education Act (IDEA).

An innovative and meticulously researched guide, How Autism Is Reshaping Special Education sheds light on a modern day conundrum: while special education in the United States is based on the concept of access—public schools are open to all children—access is no longer a sufficient foundation. Approaches that lead to academic success are increasingly demanded for those with learning disabilities, while functional, independent-living, and employable skills are requisite, but rare, for those with serious handicapping conditions.
In their groundbreaking new book, the authors explain how four major events have transpired since the last reauthorization of IDEA : the increase in the number of children diagnosed with autism, the rise of applied behavior analysis, the birth of social media, and the reality of unbundling. In addition to examining how these four events will dramatically impact the next iteration of federal law, How Autism Is Reshaping Special Education explores the effect of these events on a special education process burdened by regulation, where advances in the behavioral sciences and neurosciences blur the lines between education and medicine, and where social media fosters aggressive advocacy for specific disabilities.
In crafting the book, Claypool and McLaughlin, authors of the award-winning We’re In This Together: Public-Private Partnerships in Special and At-Risk Education, sought the expertise and input of dozens of educators, parents, leaders, experts, administrators, special education professionals, and others as a means of presenting a sensitive and accurate portrait of autism and special education today. These perspectives, featured prominently throughout the book, underscore the need for change to benefit children with autism spectrum disorders and their families. Moreover, How Autism Is Reshaping Special Education addresses such topics as: current development of the profession of applied behavior analysis; relative position of autism compared to other disabilities inside of special education; how advocacy for special needs communities has become more aggressive; how Autism Speaks became a business disruptor among advocacy groups; the impact of social media on advocacy; how IDEA will be affected by the political phenomenon of unbundling; and more.
A clear, comprehensive and compelling guide, How Autism Is Reshaping Special Education will be available where fine books are sold in March.

Thursday, March 23, 2017

Gorsuch: Sorry

In The Politics of Autism, I write about IEPs and FAPE.

At The Hill, Nikita Vladimirov reports on a telling exchange that took place on the day of Endrew F.:
President Trump's Supreme Court nominee, Neil Gorsuch, said Wednesday that he was "sorry" for ruling against an autistic student because he was "bound by circuit precedent." 
Gorsuch remarked on his ruling in favor of a Colorado school district over an autistic student after Sen. Dick Durbin (D-Ill.) asked him about the decision during Wednesday's confirmation hearing.

"If anyone is suggesting that I like a result where an autistic child happens to lose, that’s a heartbreaking accusation to me. Heartbreaking," Gorsuch said.

"But the fact of the matter is I was bound by circuit precedent, and so was the panel of my court," he added, while noting that there are other examples where his 10th U.S. Circuit Court of Appeals ruled for children with disabilities. 
"If I was wrong, senator, I was wrong because I was bound by circuit precedent, and I’m sorry," he said.

Environmental Risks

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 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. 
A mountain of research has been conducted and published on a possible link between vaccines and autism, with hundreds of advocacy and scientific organizations refuting it. They also point out the public health risk of avoiding vaccinations. Yet the fear this unsubstantiated link has generated has led to the re-emergence of vaccine-preventable diseases such as measles and pertussis. Another consequence of the ongoing media attention paid to the issue is a misunderstanding of the real environmental risk factors associated with autism.
... 
Here are a few examples of environmental factors that that have been linked to autism:
Exposure to these factors elevates a child’s risk of developing autism anywhere between two and four times. An exhaustive review of these factors was just published in the Annual Review of Public Health.

Wednesday, March 22, 2017

Endrew F. Wins!

In The Politics of Autism, I write about IEPs and FAPE.

Today, in a unanimous decision crafted by Chief Justice John Roberts, the Supreme Court decided that the Individuals with Disabilities Education Act (IDEA) requires public schools to provide a heightened level of educational benefits for children with disabilities. This new and heightened standard will impact the crafting of individualized education programs (IEPs) for those students. 
Although a lower appeals court believed that school districts would satisfy the IDEA if they offered the student an IEP that provides a benefit that is “merely more than de minimis,” the Supreme Court rejected this standard in favor of a “markedly more demanding” standard holding that IDEA “requires an educational program reasonably calculated to enable a child to make progress appropriate in light of the child’s circumstances.” The decision is likely to require a rethinking of the benefits to disabled students provided by public school districts across the country, and is expected to lead to increased litigation challenging the provision of disability benefits provided by those schools (Endrew F. v. Douglas County School District).

Injury and Death

The Politics of Autism discusses the dangers facing autistic people, including wandering.

A release from Columbia University:
Deaths in individuals with autism increased 700 percent in the past 16 years and were three times as likely as in the general population to be caused by injuries, according to a new study by Columbia University’s Mailman School of Public Health. The findings are published online in the American Journal of Public Health. The average age at death for individuals with autism was 36 years younger than for the general population, 36 years of age compared with 72. Of the deaths in individuals with autism, 28 percent were attributed to injury, most often by suffocation, followed by asphyxiation, and drowning. Together, these three causes accounted for nearly 80 percent of the total injury mortality in children with autism. More than 40 percent occurred in homes or residential institutions. “While earlier research reported a higher mortality rate overall for individuals with autism, until now injury mortality in the autism spectrum disorder population had been understudied,” said Guohua Li, MD, DrPH, Mailman School professor of Epidemiology, and senior author. “Despite the marked increase in the annual number of deaths occurring, autism-related deaths still may be severely underreported, particularly deaths from intentional injury such as assaults, homicide, and suicide.”
Screening over 32 million death certificates in the U.S. National Vital Statistics System, the researchers identified 1,367 individuals (1,043 males and 324 females) with a diagnosis of autism who died between 1999 and 2014.   The annual number of documented deaths for individuals with a diagnosis of autism has risen nearly 7 times from 1999 to 2014. “Our study was limited to death certificate data. While the numbers are startling, autism as a contributing cause of death is likely undercounted because of the accuracy of information on death certificates filed by coroners varies,” noted Joseph Guan, the lead author and a master of public health degree student in Epidemiology at the Mailman School of Public Health.    The estimated prevalence of autism spectrum disorder is about four times as common in males as in females and higher among non-Hispanic white children and in children of highly educated parents. From 2000 to 2012, the rate has more than doubled. “Our analysis reveals that children with autism are 160 times as likely to die from drowning as the general pediatric population.  Given the exceptionally heightened risk of drowning for children with autism, swimming classes should be the intervention of top priority,” said Dr. Li, who is the founding director of the Center for Injury Epidemiology and Prevention at Columbia. “Once a child is diagnosed with autism, usually between 2 years and 3 years of age, pediatricians and parents should immediately help enroll the child in swimming classes, before any behavioral therapy, speech therapy, or occupational therapy. Swimming ability for kids with autism is an imperative survival skill.” 
Wandering is a common autistic behavior, and Dr. Li makes the point that many children with autism have an affinity to bodies of water. “With impaired communication and social skills, autistic kids tend to seek relief of their heightened anxiety from the serenity of water bodies. Unfortunately, this behavior too often leads to tragedies.” 
The study was supported by the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (grant 1 R49 CE002096).

Tuesday, March 21, 2017

Autistic Aging

When disabled people reach their 22d birthday, they no longer qualify for services under IDEA. ... People in the disability community refer to this point in life as “the cliff.” Once autistic people go over the cliff, they have a hard time getting services such as job placement, vocational training, and assistive technology. IDEA entitles students to transition planning services during high school, but afterwards, they have to apply as adults and establish eligibility for state and federal help. One study found that 39 percent of young autistic adults received no service at all, and most of the rest got severely limited services.
Elizabeth A. Wise, Marcia D. Smith, and Peter V. Rabins have an article at The Journal of Autism and Developmental Disorders titled "Aging and Autism Spectrum Disorder: A Naturalistic, Longitudinal Study of the Comorbidities and Behavioral and Neuropsychiatric Symptoms in Adults with ASD."

 The abstract:
Little is known about Autism Spectrum Disorder (ASD) in persons over age 50. In a retrospective, naturalistic review of 74 individuals aged 30 and older meeting DSM-5 criteria for ASD, the point prevalence of behavioral and neuropsychiatric symptoms (BNPS) declined significantly for 12 of 13 BNPS over a mean of 25 years while many other features of ASD remained stable. GI disorders (68.9%) and seizure disorders (23%) were common, and 25.7% of the sample had a BMI >30. Females were more likely to engage in screaming (p < 0.05) and oppositional behavior (p < 0.05). Current age did not have a significant effect on BNPS prevalence.
From the article:
Older adults in this cohort required a high level of support as ascertained by their treatment plans. We were unable to determine staffing levels when people entered the program, so we cannot comment on change in need for supervision over time, but it appears that the majority of people in this cohort required intensive staff support throughout, many for over 30 years. This observation is notable for several reasons. For one, it reiterates the relative stability of ASD over adulthood. Second, programs geared toward older adults with ASD—similar to those in this cohort—will need to provide levels of individual support described in this sample. The high prevalence of dental, dermatological, musculoskeletal problems, and seizures encountered in this cohort also points to the need for careful attention to those conditions, in addition to disorders that are common in the general population as people age. Moreover, it is worth noting that almost one-third of the sample require sedating medication to tolerate medical or dental care.