Tuesday, May 26, 2015

Autism and Marijuana in Michigan

At AP, Ed White writes of 6-year-old Noah Smith, whose autism symptoms seemed to improve after he took oral doses of an oil extracted from marijuana.
Noah is registered to use marijuana to control epileptic seizures; the effect on his autism was an unexpected benefit. Based on that success, Smith is asking the state of Michigan to add autism to the list of conditions that qualify for medical marijuana.

A public hearing is scheduled for Wednesday in Lansing. A committee mostly composed of health professionals will make a recommendation to the director of the Department of Licensing and Regulatory Affairs.

“I know parents who are desperate. They’re missing out on something that could enhance their child’s life,” Smith said. “A lot of children with autism don’t have another qualifying condition like Noah does with epilepsy.”

Since Michigan voters approved medical marijuana in 2008, it has been used to relieve the side effects of cancer, glaucoma, HIV, hepatitis C and a few other conditions. Post-traumatic stress disorder was the first addition a year ago. Nearly 200 people under age 18, a tiny fraction of the total, are approved to use marijuana.

In 2013, the state’s Medical Marijuana Review Panel voted against making autism eligible, 7-2. There was skepticism about the effectiveness and a concern about adding more children to the registry. But the new effort seems more organized with more doctors willing to speak in favor, including Noah’s doctor, Dr. Harry Chugani, chief of pediatric neurology at Children’s Hospital of Michigan in Detroit.
Earlier this year, Scott Hadland and colleagues looked at the research for an article titled "Medical Marijuana: Review of the Science and Implications for Developmental-Behavioral Pediatric Practice," in The Journal of Developmental & Behavioral Pediatrics.  Their conclusion:
Given the current scarcity of data, cannabis cannot be safely recommended for the treatment of developmental or behavioral disorders at this time. [emphasis added] At best, some might consider its use as a last-line therapy when all other conventional therapies have failed.90,91 As marijuana policy evolves and as the drug becomes more readily available, it is important that practicing clinicians recognize the long-term health and neuropsychiatric consequences of regular use. Although a decades-long public health campaign has showcased the harms of cigarette smoking, similar movements to illustrate the hazards of cannabis use have not been as rigorous or successful. As a result, accurate information on regular cannabis use remains poorly disseminated to patients, families, and physicians. Furthermore, there are especially few studies examining neurocognitive and psychiatric outcomes among children and adolescents with developmental or behavioral concerns who are exposed to cannabis, and this remains a critical area for future study. In coming to the decision to use marijuana for medicinal purposes, all parties should be fully aware of the long-term hazards of regular cannabis use, recognize the lack of evidence on its efficacy in developmental and behavioral conditions, and incorporate this information into a careful risk-benefit analysis.

Monday, May 25, 2015

Autism and Crime: A Review of Studies

Many posts have discussed autism and crimeKatie MarasSue Mulcahy, and Laura Crane write at Autism:
The journal, Autism, enjoys a wide readership that extends far beyond academia. We set out here, for the benefit of the whole readership, to debunk the myth that autism causes criminal behaviour. We review the little research on this topic and describe how easily negative stereotypes can be reinforced by press reports.
King and Murphy (2014) conducted a thorough review of the research in this area. They found that on the whole, there is no evidence that people with autism are more likely to engage in criminal activity than people without autism. The studies they reviewed presented conflicting information, however. Some studies have found that people with autism are less likely to commit offences such as probation violations and property offences (Cheely et al., 2012; Kumagami and Matsuura, 2009), and another study reported that people with autism are no more likely to commit violent crime than the general population (Woodbury-Smith et al., 2006). On the other hand, some people with autism may be more likely than the general population to commit certain types of offences such as arson (Hare et al., 1999; Mouridsen et al., 2008), sex offences (Cheely et al., 2012; Kumagami and Matsuura, 2009) and assault and robbery (Cheely et al., 2012).
Research on autism and offending needs to be interpreted with caution, however. Most studies rely on information from small samples that do not represent the general population. These studies also rarely include people without autism for comparison. This makes it inappropriate to attempt to generalise these studies to the autism population at large. For example, two studies found a disproportionately high prevalence of autism in high security hospitals (e.g. Hare et al., 1999; Scragg & Shah, 1994), but this does not mean that the autism population as a whole includes a disproportionate percentage of people who present a danger to society.
There are also several case reports of people with autism engaging in criminal behaviour (e.g. Baron-Cohen, 1988; Mawson et al., 1985). However, generalisations cannot be made on the basis of individual cases regardless of whether these reports originate in the research literature or in the press, not least because it is often the unusual characteristics in such cases (e.g. the bizarre and random acts of violence noted by Mawson et al., 1985) that initially draw attention for analysis.

Sunday, May 24, 2015

Vaccine Exemption Limit in Maine

In Maine, the Portland Press-Herald reports:
Maine parents would have to consult with doctors before exempting their children from vaccinations required by public schools, under a bill that won endorsement from a legislative committee Friday.
But despite Maine’s relatively high vaccine opt-out rates, the Legislature’s Health and Human Services Committee voted unanimously to reject a separate bill that would have eliminated the philosophical exemption that has sparked a heated debate over vaccine safety and “herd immunity.”

The committee voted 9-3 in support of L.D. 471, the bill that would require any parent who seeks a philosophical exemption from vaccines to first consult with a medical professional and obtain a signature. Lawmakers from both parties supported the measure; the three dissenting votes were cast by Republicans.
“There are risks in every medical procedure and other things that we do in life, and I think parents have a right to weigh those risks,” said committee co-chair Rep. Drew Gattine, D-Westbrook. “But I think this is an important step to make sure that important conversation happens with respect to something that doesn’t just protect the child being vaccinated, but other children as well.”
The bill could face tougher votes in the House and Senate, and a potential veto by Gov. Paul LePage.
Maine now allows parents to opt out of required vaccines for their children on both philosophical and religious grounds. The vast majority of exemptions are for philosophical reasons, a trend that reflects concerns in some segments of the population that childhood vaccinations could trigger autism or health problems.

Saturday, May 23, 2015

Voting Rights in Los Angeles County

Stephen Ceasar reports at The Los Angeles Times on Teresa Thompson, who learned that her autistic son could not vote if he were under a guardianship.
Thompson complained to a local disability rights group in Los Angeles, setting off a chain of events that led this week to federal authorities announcing they are investigating allegations that California has systematically and illegally denied intellectually disabled residents such as Lopate the right to vote.

The group, the Disability and Abuse Project, filed a complaint last year with the U.S. Department of Justice contending that the Los Angeles County Superior Court has wrongly stripped people under limited conservatorships of the right to vote if they could not fill out a voter registration affidavit.

Nora J. Baladerian, the group's executive director, said the issue impacts some of society's most vulnerable citizens, including people with cerebral palsy, autism spectrum disorder and traumatic brain injury, among other intellectual disabilities.

"Naïve me. I thought in the courtroom the law was followed," Baladerian said. "It wasn't so. The rights of individuals with disabilities were not being upheld in court."

It is unclear how many people under conservatorship have their right to vote taken away each year. A spokesman for the county's Registrar of Voters said 123 voters had their registrations canceled since January 2014 for "mental incompetence."

A lawyer with Baladerian's group conducted a review of 61 conservatorship cases involving adults with developmental disabilities in L.A. County and found that nearly 90% of the people had been disqualified from voting, according to the group's complaint.

Friday, May 22, 2015

Physicians and Autistic Adults

Michelle Diament reports at Disability Scoop:
A new survey finds many health care providers admittedly know little about how to care for adults with autism...The issue is significant as an increasing number of individuals with autism are expected to enter adulthood in the coming years, Maria Massolo with the Autism Research Program at Kaiser Permanente Northern California and her colleagues said in their findings.
The abstract:
A Mixed Methods Study of Physician Knowledge and Experience with Autism in Adults
Friday, May 15, 2015

M. L. Massolo, O. Zerbo, Y. Qian and L. A. Croen, Division of Research, Kaiser Permanente Northern California, Oakland, CA
Background:  As children with autism become adults their primary medical care will move from pediatrics to adult medicine. There is little evidence of knowledge about autism among adult healthcare providers, and of their readiness to provide optimal care for this adult population.
Objectives:  To determine adult healthcare providers’ general knowledge about autism, and gain an understanding of their experiences and needs in providing healthcare to adult patients with autism.
Methods: This mixed methods study consisted of a brief, online survey sent to Kaiser Permanente Northern California (KPNC) providers in adult medicine, mental health and Ob/Gyn, and semi-structured follow-up interviews with physicians in adult medicine. The 11-question survey assessed healthcare providers’ ability to recognize autism, knowledge of autism, comfort level treating patients with autism, and training and resource needs.  Follow-up interviews focused on autism training in medical school, experience caring for patients with autism, resources and training needs, challenges of clinical care, impact on visit schedule, screening for sex, drugs, and alcohol, concerns brought up by patients or caregivers, and transition from pediatrics to adult medicine.  
Results: Overall, 922 providers completed the survey (response rate 25.3%). More than 90% indicated that they would explore the possibility of ASD in a patient who had limited eye contact, and the majority recognized other autism characteristics. A high proportion under-reported the actual number of patients with ASD in their panel and rated their knowledge/skills in providing care to ASD patients as poor or fair (77%).  Only 13% agreed/ strongly agreed that they had adequate tools/referral resources to accommodate patients with autism in their practice. The majority indicated the usefulness of the following: an autism conference (66%), a checklist of community resources (77%), training on effective communication strategies with autistic patients (70%), a special primary care clinic to serve adults with developmental disabilities (64%), and training about use of psychotropic drugs for autistic patients (56%). Finally, 43% indicated willingness to participate in a follow-up telephone interview.
 Nine primary care physicians were interviewed.  The majority reported receiving little or no ASD training in medical school or residency, yet many said they were comfortable treating their patients with ASD.  Communication difficulties, primarily with patients with limited verbal abilities, were the most frequently experienced frustrations.  Some made adaptations for their patients with ASD. Many indicated that longer office visits with low functioning patients were not a problem.  Conservatorship and privacy issues were mentioned by physicians treating patients who bring caretakers to visits, and several stated that they did not bring up questions about sex, drugs and alcohol with their patients with ASD. All physicians stated that the hand-off between pediatrics and adult medicine requires improvement, and all highlighted a need for training.
Conclusions: Most adult healthcare providers recognized basic autism characteristics but reported not having adequate skills and tools to care for this growing population of adult patients. Provider training, resources, and improvements in the transition from pediatrics to adult medicine are essential to support the delivery of adequate and effective healthcare to adults with ASD.

Thursday, May 21, 2015

Anti-Vax Stalkers

Jeremy B. White reports at The Sacramento Bee:
The California Medical Association has sent a letter warning a California Chiropractic Association official who they say encouraged opponents of a mandatory vaccination bill to stalk lobbyists advocating for the legislation.

The emotional debate over Senate Bill 277, which would make vaccinations compulsory for California schoolchildren and passed the Senate last week, has taken a personal turn in recent weeks. Lobbyists championing the bill on behalf of the California Medical Association and the California Academy of Family Physicians have attracted the attention of bill opponents, who have begun sharing information on the lobbyists and disseminating photos of their locations on social media.
California Chiropractic Association President Brian Stenzler has spurred them on, according to a letter signed by California Medical Association CEO Dustin Corcoran, with a video in which Stenzler tells an SB 277 opponent who asks about the two lobbyists to follow them “all day long – follow them to a T.”
Also at The Bee, Shawn Hubler picks up the story:
[Stenzler] says now that he meant “follow the money.” But the video, posted on Facebook (and recently removed), sent the campaign against Hicks, a 43-year-old mother of three, into warp speed.
“Hey, Jodi!” someone yelled as she crossed the street. When she turned, a bevy of red-shirted “No on SB 277” women snapped her picture. Moments later, it was up on Twitter.
“#wheresJodi,” the caption sneered. “#DevilWithTheBlueDress.”
“There’s a special place in hell for you, just waiting,” warned the mean tweets.
“#wearewatchingyou.”
“People were on blogs saying, if somebody shoots my kids with needles, maybe we should shoot these lobbyists,” said Hicks’ understandably distraught husband, Paul Mitchell. “And here’s the president of this association, actually inciting people to stalk my wife.”

A Forthcoming Book

From Rowman and Littlefield:

The Politics of Autism

Navigating The Contested Spectrum

JOHN J. PITNEY

Hardback 
In The Politics of Autism, John J. Pitney, one of America’s leading experts on public policy, explains how the political issues of autism have emerged and analyzes the accompanying disputes in the areas of science, education, and social services, among others. The result is a fascinating look at how public policy is made and implemented at the federal, state, and local government that will also be of vital interest to the network of concerned parents, educators, and researchers in the autism community.
Rowman & Littlefield Publishers
Pages: 180 • Size: 6 x 9
978-1-4422-4960-8 • Hardback • August 2015 • $38.00 • (£24.95)
978-1-4422-4961-5 • eBook • September 2015 • $37.99 • (£24.95)