A Five Billion Dollar Business

 The Politics of Autism includes an extensive discussion of autism service providers.

From Market Research Future:

• The global autism disorder & treatment market was USD 5,143.6 million in 2016
• The pervasive developmental disorder is the largest segment, by type which is projected to grow at a CAGR [compound annual growth rate ] of 4.73% during the forecast period from 2017–2023.
• ABA is the largest segment, by treatment type in global and expected to grow at a rate of CAGR 4.82% during the forecast period
• The anti-psychotic accounted for the largest market share in global autism disorder & treatment market by drugs and is expected grow with the CAGR of 3.95% for the forecast period.

Measles Case Soar in Europe

In The Politics of Autism, I look at the discredited notion that vaccines cause autism..

From the World Health Organization:

Over 41 000 children and adults in the WHO European Region have been infected with measles in the first 6 months of 2018. The total number for this period far exceeds the 12-month totals reported for every other year this decade. So far, the highest annual total for measles cases between 2010 and 2017 was 23 927 for 2017, and the lowest was 5273 for 2016. Monthly country reports also indicate that at least 37 people have died due to measles so far this year.

“Following the decade’s lowest number of cases in 2016, we are seeing a dramatic increase in infections and extended outbreaks,” says Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “We call on all countries to immediately implement broad, context-appropriate measures to stop further spread of this disease. Good health for all starts with immunization, and as long as this disease is not eliminated we are failing to live up to our Sustainable Development Goal commitments.”

Seven countries in the Region have seen over 1000 infections in children and adults this year (France, Georgia, Greece, Italy, the Russian Federation, Serbia and Ukraine). Ukraine has been the hardest hit, with over 23 000 people affected; this accounts for over half of the regional total. Measles-related deaths have been reported in all of these countries, with Serbia reporting the highest number of 14.

Rory Smith at CNN:

And where anti-vaccine sentiment has taken root -- such as in Italy -- measles is generally the first disease to manifest given its contagiousness, according to Heidi Larson, of the London School of Hygiene and Tropical Medicine.

Italy's anti-establishment government recently passed a new amendment that suspends a law requiring parents to provide proof that their children received a series of 10 vaccines -- including the MMR (measles, mumps, and rubella) vaccine -- when enrolling them in nurseries and preschools.

"Now, children who are not vaccinated will endanger other children at school who are too small for vaccines or cannot be vaccinated because they suffer from immunosuppressive diseases," said Dr. Roberto Burioni, a professor of microbiology and virology at San Raffaele University in Milan.

France and Romania, along with Italy, are among European countries with the highest anti-vaccine sentiment, where around 20% of the population believes vaccines are unsafe.

The infamous Wakefield study pubished in 1998 stated that the MMR vaccine caused autism in children who received the vaccine. The results of the study turned out to be untrue and Andrew Wakefield, one of the authors of the study, had his medical license revoked.

Despite the medical fraud, the myth persists, and many vaccine skeptics still believe their children will develop autism if they are immunized.

Inequities in Age of Treatment Receipt

In The Politics of Autism, I write about the experiences of different economic, ethnic and racial groups. 

Marissa E Yingling and Bethany A Bell have an article at Autism titled Racial-ethnic and Neighborhood Inequities in Age of Treatment Receipt among a National Sample of children with Autism Spectrum Disorder."  The abstract:

From the article:

This study, which is the first to examine inequity in age of treatment receipt among a nationally representative sample of children with ASD, demonstrates inequitable access to treatment. Specifically, we detected relationships between age of treatment receipt and two predisposing social characteristics, or race-ethnicity and perceived neighborhood cohesion. It is concerning that compared to White children, the odds of entering treatment at 3 years and ⩾4 years were much greater for non-Hispanic Black children. This finding aligns with consistent evidence that Black children with ASD are diagnosed later and are initially misdiagnosed (Daniels and Mandell, 2013).

...
After controlling for child race-ethnicity and covariates, children whose parents perceived their neighborhood to be cohesive began treatment earlier than children whose parents did not. Byrnes and Miller (2012) reported that the positive relationship between perceived neighborhood cohesion and effective parenting behaviors is mediated through social support. Thus, parents who perceive neighborhood cohesion might perceive greater social support from and more frequently communicate with neighbors and more often interact with other parents and young children. In turn, these parents might be more likely to compare and discuss their child’s development, including available community resources that promote development. To the contrary, parents who do not perceive  neighborhood cohesion might not receive feedback about their child’s development until preschool or later.

One in Four Adults Has a Disability

In The Politics of Autism, I discuss the  civil rights of people with autism and other disabilities. 

From CDC:

One in 4 U.S. adults – 61 million Americans – have a disability that impacts major life activities, according to a report in CDC’s Morbidity and Mortality Weekly Report.
The most common disability type, mobility, affects 1 in 7 adults. With age, disability becomes more common, affecting about 2 in 5 adults age 65 and older.

“At some point in their lives, most people will either have a disability or know someone who has a one,” said Coleen Boyle, Ph.D., director of CDC’s National Center on Birth Defects and Developmental Disabilities. “Learning more about people with disabilities in the United States can help us better understand and meet their health needs.”

Six types of disability measured

Using data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS), this is the first CDC report of the percentage of adults across six disability types:

• Mobility (serious difficulty walking or climbing stairs)
• Cognition (serious difficulty concentrating, remembering, or making decisions)
• Hearing (serious difficulty hearing)
• Vision (serious difficulty seeing)
• Independent living (difficulty doing errands alone)
• Self-care (difficulty dressing or bathing)

These data show that disability is more common among women, non-Hispanic American Indians/Alaska Natives, adults with lower income, and adults living in the South Census region of the United States. The report also shows that:

• After mobility disability, the next most common disability type is cognition, followed by independent living, hearing, vision, and self-care.
• The percentage of adults with disability increased as income decreased. In fact, mobility disability is nearly five times as common among middle-aged (45- to 64-year old) adults living below the poverty level compared to those whose income is twice the poverty level.
• It is more common for adults 65 years and older with disabilities to have health insurance coverage, a primary doctor, and receive a routine health checkup during the previous 12 months, compared to middle-aged and younger adults with disabilities.
• Disability-specific differences in the ability to access health care are common, particularly among adults 18- to 44-years old and middle-aged adults. Generally, adults with vision disability report the least access to health care, while adults with self-care disability report the most access to care.

“People with disabilities will benefit from care coordination and better access to health care and the health services they need, so that they adopt healthy behaviors and have better health,” said Georgina Peacock, M.D., M.P.H., Director of CDC’s Division of Human Development and Disability. “Research showing how many people have a disability and differences in their access to health care can guide efforts by health care providers and public health practitioners to improve access to care for people with disabilities.”

CDC is committed to protecting the health and well-being of people with disabilities throughout their lives. Through its State Disability and Health Programs and national collaborations, CDC will continue to work to lower health differences faced by people with disabilities. To advance this goal, CDC provides information and resources for public health practitioners, doctors, and those who care for people with disabilities.

For more information about CDC’s work to support inclusive settings for people with disabilities, go to http://www.cdc.gov/disabilities.

Measles Redux

In The Politics of Autism, I look at the discredited notion that vaccines cause autism.

From CDC:

From January 1 to July 14, 2018, 107 people from 21 states (Arkansas, California, Connecticut, Florida, Illinois, Indiana, Kansas, Louisiana, Maryland, Michigan, Missouri, Nevada, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, and Washington) and the District of Colombia were reported to have measles.

In 2017, 118 people from 15 states and the District of Columbia were reported to have measles. In 2016, 86 people from 19 states were reported to have measles. In 2015, 188 people from 24 states and the District of Columbia were reported to have measles. In 2014, the United States experienced a record number of measles cases, with 667 cases from 27 states reported to CDC’s National Center for Immunization and Respiratory Diseases (NCIRD); this is the greatest number of cases since measles elimination was documented in the U.S. in 2000.

• The majority of people who got measles were unvaccinated.
• Measles is still common in many parts of the world including some countries in Europe, Asia, the Pacific, and Africa.
• Travelers with measles continue to bring the disease into the U.S.
• Measles can spread when it reaches a community in the U.S. where groups of people are unvaccinated.

DDT and Autism

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;
• Fever  
• Birth by cesarean section;
• Maternal and paternal obesity;
• Maternal diabetes;
• Maternal and paternal age;
• Maternal post-traumatic stress disorder;
• Smoking during pregnancy;
• Antidepressant use during pregnancy;
• Polycystic ovary symdrome.

Sara Reardon at Nature:

Mothers with high levels of the pesticide DDT in their blood during pregnancy are more likely to bear children who develop autism, according to a study of blood samples from more than one million pregnant women in Finland.

The World Health Organization estimates that globally, one in 160 children has autism. Any case of autism is likely due to a number of factors, including genetics and other environmental exposures.

Although the authors stress that the findings do not prove that autism is caused by DDT — whose use has been banned in many countries for decades over concerns about its effects on wildlife— it is the first such association using a direct measure of exposure to the pesticide. Researchers who investigate links between environment and disease say that further studies are needed to determine the mechanism, if any, by which DDT exposure could trigger autism.

The study, published on 16 August in the American Journal of Psychiatry, also examined mothers’ exposure to another set of chemicals known as polychlorinated biphenyls (PCBs), and found no association between these substances and autism. That finding deepens questions about whether or how DDT might be linked to autism.

Texas Must Spend More for Special Ed

In The Politics of Autism, I write about special education and the Individuals with Disabilities Education Act.

Alejandra Matos at The Houston Chronicle reports that Texas must spend billions more on special education.

A 2016 Houston Chronicle investigation and a subsequent federal auditfound that the Texas Education Agency illegally set up an 8.5 percent benchmark, or de-facto cap, on the number of students receiving special education services. The cap was in place for more than a decade, and was well below the national average of 13 percent.

In eliminating that cap, state officials estimate that it will cost the state billions of dollars to provide special education services to an additional 189,000 students who need them.

The state legislature eliminated caps on special education services last year, and the federal government is requiring school districts to evaluate special needs students and offer compensatory services. As more students are identified, the state will have to pay for those resources. TEA officials told a group of lawmakers Thursday that it estimates the state will need an additional $682 million for special education services in fiscal year 2019, an additional $1 billion in 2020 and $1.55 billion in 2021. That's more than $3.2 billion in the next three years.