Thursday, October 23, 2014

Another Pollution Study

Science 2.0 reports:
Children with autism spectrum disorder, a range of conditions characterized by social deficits and communication difficulties, were more likely to have been exposed to higher levels of certain air toxics during their mothers' pregnancies and the first two years of life compared to children without the condition, according to preliminary findings presented today at the American Association for Aerosol Research annual meeting in Orlando.
Other epidemiologists have linked everything from living near farms to organic food [not really] to autism, and such studies don't actually measure anything, they just find a map of autism and then correlate it to an environmental factor, in this instance pollution and autism instances in southwestern Pennsylvania.

Evelyn Talbott, Dr.P.H., professor of epidemiology at the University of Pittsburgh, and colleagues analyzed data on families with and without ASD living in six southwestern Pennsylvania counties. They correlated autism with increased levels of chromium and styrene. They interviewed 217 families of children with ASD and compared these findings with information from two separate sets of comparison families of children without ASD born during the same time period within the six-county area. The families lived in Allegheny, Armstrong, Beaver, Butler, Washington and Westmoreland counties, and the children were born between 2005 and 2009.

For each family, the team used the Environmental Protection Agency's (EPA) National Air Toxics Assessment (NATA) to estimate the exposure to 30 pollutants known to cause endocrine disruption or neurodevelopmental issues.

Based on the child's believed exposure (they didn't actually measure anything in anyone) [emphasis added]  to concentrations of air toxics during the mother's pregnancy and the first two years of life, the researchers noted that children who fell into higher exposure groups to styrene and chromium were at a 1.4-2X greater risk of ASD, after accounting for the age of the mother, maternal cigarette smoking, race and education. Other NATA compounds associated with increased risk included cyanide, methylene chloride, methanol and arsenic.
Note the bolded text.  This study suffers from the same problem as previous studies of air pollution and autism:  it estimates exposure from location rather than measuring exposure directly.

Wednesday, October 22, 2014

ASD in Michigan

An October 14 release from the Center for Healthcare Research & Transformation:
A report examining current implementation of new autism laws in Michigan, released today by the Center for Healthcare Research and Transformation, reveals a changing environment for autism care.
Under these laws, state-regulated insurance plans must cover diagnosis and medically necessary treatment for children with autism spectrum disorder (ASD) from birth through 18 years and Medicaid and MIChild must now cover a specific evidence-based behavioral therapy, known as applied behavior analysis (ABA), for children with ASD from 18 months through age 5.
The brief, Autism Spectrum Disorder in Michigan, released in partnership with the Michigan Department of Community Health, examines how the new laws have enabled many children to be covered for treatment.
Michigan’s autism policy changes aim to increase access to evidence-based treatments, and what we have seen following implementation is that this is true for many children in Michigan,” says Marianne Udow-Phillips, CHRT director. “For example, 1,300 children with private insurance or Medicaid have received applied behavior analysis therapy.”
In addition to expanding treatment coverage, the Michigan Legislature established a state fund to reimburse insurance carriers and self-funded plans that submit claims for the diagnosis and treatment of ASD. This is particularly important for self-insured plans, which are federally-regulated and are not required to follow these new coverage requirements. As of June 2014, 23 self-insured employers had begun offering the benefit, with many submitting ASD claims to the fund for reimbursement.
This transformation in coverage for autism treatment also brings some challenges in accessing care for families with autistic children. For example, before a child can obtain approved, covered applied behavior analysis therapy (ABA) therapy, Michigan requires that a medical diagnosis of ASD come from a designated provider. Currently, estimated wait times for privately-insured children to be evaluated range between one month and 24 months.
Another factor that can delay treatment is the limited number of credentialed ABA providers in the state. Depending on an individual’s insurance, ABA must be provided or supervised by a board-certified behavior analyst. As of September 2014, there were 248 certified behavior analysts in Michigan, of which fewer than half treated individuals with ASD. An expansion of university training programs may help meet the demand for services in the coming years. For example, MDCH allocated more than $2 million in funding to help several universities expand their training programs for behavior analysts and assistant behavior analysts.

Tuesday, October 21, 2014

Education Department Guidance on Bullying

A guidance from the Education Department's Office for Civil Rights:
While there is broad consensus that bullying is wrong and cannot be tolerated in our schools, the sad reality is that bullying persists in our schools today, and especially so for students with disabilities.In recent years, the Office for Civil Rights (OCR) in the U.S. Department of Education (Department) has received an ever-increasing number of complaints concerning the bullying of students with disabilities and the effects of that bullying on their education, including on the special education and related services to which they are entitled. This troubling trend highlights the importance of OCR’s continuing efforts to protect the rights of students with disabilities through the vigorous enforcement of Section 504 of the Rehabilitation Act of 1973 (Section 504) and Title II of the Americans with Disabilities Act of 1990 (Title II). It also underscores the need for schools to fully understand their legal obligations to address and prevent disability discrimination in our schools.
Today’s guidance follows a long history of guidance issued by the Department in this critical area of disability discrimination. In 2000, OCR and the Office of Special Education and Rehabilitative Services (OSERS) issued joint guidance informing schools that disability-based harassment may deny a student equal educational opportunities under Section 504 and Title II.The 2000 guidance also noted the responsibilities of schools under Section 504 and the Individuals with Disabilities Education Act (IDEA) to ensure that students receive a free appropriate public education (FAPE), and alerted schools that harassment of a student based on disability may adversely impact the school’s provision of FAPE to the student.3 In 2010, OCR issued a Dear Colleague Letter on Harassment and Bullying that provided further guidance concerning when a school’s inappropriate response to bullying or harassment of a student based on disability constitutes a disability-based harassment violation under Section 504 and Title II.4 In 2013, OSERS issued a Dear Colleague Letter on Bullying of Students with Disabilities that, in turn, provided additional guidance to schools that the bullying of a student with a disability on any basis can result in a denial of FAPE under IDEA that must be remedied.5  
Building on OSERS’s 2013 guidance, today’s guidance explains that the bullying of a student with a disability on any basis can similarly result in a denial of FAPE under Section 504 that must be remedied; it also reiterates schools’ obligations to address conduct that may constitute a disability based harassment violation and explains that a school must also remedy the denial of FAPE resulting from disability-based harassment. Following an overview of the federal protections for students with disabilities in schools, the guidance elaborates on the elements of a disability-based harassment violation and a FAPE violation, discusses how OCR generally analyzes complaints involving bullying of students with disabilities on each of these bases, and then concludes with a series of hypothetical examples that illustrate varying circumstances when conduct may constitute both a disability-based harassment violation and FAPE violation, a FAPE violation, or neither. Although by no means exhaustive, in the context of this discussion, the guidance also offers some insight into what OCR might require of a school to remedy instances of bullying upon a finding of disability discrimination. OCR urges schools to consider these hypothetical resolution agreement provisions in proactively working to ensure a safe school environment, free from discrimination, for all students.6
1 These students are bullied or harassed more than their nondisabled peers. See Office of Special Education and Rehabilitative Services (OSERS) 2013 Dear Colleague Letter on Bullying of Students with Disabilities, http://www.ed.gov/policy/speced/guid/idea/memosdcltrs/bullyingdcl-8-20-13.doc, at page 2 (“Students with disabilities are disproportionately affected by bullying.”). That letter explains that, “[b]ullying can involve overt physical behavior or verbal, emotional, or social behaviors (e.g., excluding someone from social activities, making threats, withdrawing attention, destroying someone’s reputation) and can range from blatant aggression to far more subtle and covert behaviors. Cyberbullying, or bullying through electronic technology (e.g., cell phones, computers, online/social media), can include offensive text messages or e-mails, rumors or embarrassing photos posted on social networking sites, or fake
online profiles.” Id. Throughout this guidance, the terms “bullying” and “harassment” are used interchangeably to refer to these types of conduct. See Office for Civil Rights (OCR) 2010 Dear Colleague Letter on Harassment and Bullying, http://www.ed.gov/ocr/letters/colleague-201010.pdf, at page 3 (“The label used to describe an incident (e.g., bullying, hazing, teasing) does not determine how a school is obligated to respond. Rather, the nature of the conduct itself must be assessed for civil rights implications.”).
2 OCR-OSERS 2000 Dear Colleague Letter: Prohibited Disability Harassment,
http://www.ed.gov/ocr/docs/disabharassltr.htm

3 The terms “school” and “school district” are used interchangeably in this letter and refer to public elementary and secondary schools that receive financial assistance from the Department.
4 OCR 2010 Dear Colleague Letter on Harassment and Bullying, http://www.ed.gov/ocr/letters/colleague-201010.pdf.
5 OSERS 2013 Dear Colleague Letter on Bullying of Students with Disabilities,
http://www.ed.gov/policy/speced/guid/idea/memosdcltrs/bullyingdcl-8-20-13.doc.
6 This guidance addresses only student-on-student bullying and harassment. Under Section 504 and Title II, students  with disabilities are also protected from bullying by teachers, other school employees, and third parties. Such bullying can trigger a school’s obligation to address disability-based harassment, remedy a denial of FAPE, or both. See 34 C.F.R. §§ 104.4, 104.33; 28 C.F.R. pt. 35. OCR recommends that States and school districts consult with legal counsel regarding their responsibilities and duties in cases of bullying that involve school personnel.

Monday, October 20, 2014

A Settlement in Washington State

Annie Zak reported last week at the Puget Sound Business Journal that Regence BlueShield, the largest health insurer in Washington state, settled two class-action lawsuits the previous for $6 million over its lack of coverage of ABA.
The suits, filed in federal district court and King County Superior Court by the families of children with autism, makes Regence the final health insurer among the state's three largest to get taken to court over their lack of coverage for such disabilities.The other two – Premera Blue Cross and Group Health Cooperative — also settled their cases.
According to the advocacy group Autism Speaks, Washington is one of 16 statest hat does not require insurance companies to cover behavioral treatments.
...
Eleanor Hamburger, an attorney with the plaintiffs' law firm Sirianni Youtz Spoonemoore Hamburger, said she believes one reason these therapies have been neglected by many insurance companies
"A lot of these plans had an exclusion of developmental disability services, and I think this stems from this historical perspective on people with disabilities, that they can't be cured," Hamburger said. "Research has shown that interventions on people with developmental disabilities have a big impact on their lives."
Another reason contributing to the previous lack of coverage is that the Washington state's 2005 Mental Health Parity Act, while mandating coverage for mental health services, said neurodevelopmental therapies may constitute mental health services if they are "medically necessary," according to the lawsuit. That provision meant some insurers could choose not to include autism and other neurodevelopmental treatment.
Part of that $6 million will be used to create a fund for those involved in the class action suit who paid for their own treatments during the period of the lawsuits.

Sunday, October 19, 2014

Latina Mothers and ASD Diagnosis

Jan Blacher et al have an article in Research in Autism Spectrum Disorders titled "In the Eye of the Beholder: Reports of Autism Symptoms by Anglo and Latino Mothers."  The abstract:
Latino children with autism spectrum disorder (ASD) are under-identified and under-diagnosed. Children suspected of ASD (28 Anglo and 55 Latino) were assessed via the Autism Diagnostic Observation Schedule (ADOS) and the mother Intake Form. A sub-sample of 40 children were assessed with the Autism Disagnostic Interview-Revised (ADI-R). The primary objective was to determine whether Anglo and Latino mothers differed in their symptom reports, and whether their children differed in the professional classifications. Anglo mothers reported significantly more developmental concerns and ASD symptoms than Latino mothers, yet Latino children meeting diagnostic criteria for autism on the ADOS obtained higher ASD severity scores than Anglo children. The authors set forth three possible explanations for such discrepancies between parents and professionals in perceptions and reporting of autism symptoms: (1) Latino mothers are not as aware of the symptoms, and thus do not report them; and (2) Latino mothers are aware of general developmental delay but not as concerned as Anglo mothers until social communication deficits become more apparent. (3) Latino mothers’ parenting practices and cultural beliefs about child-rearing might mask both the ASD symptomatology exhibited by their children and their recognition of it.

Saturday, October 18, 2014

Psychiatrists and Autism

At SFARI, Matthew Siegel writes about a mother whose ASD son long suffered from undiagnosed depression:
This mother’s story underscores the tremendous need for psychiatrists who are trained to care for individuals with autism. There are vanishingly few of these professionals.
A study published earlier this year suggests most child psychiatrists are exposed to fewer than ten children with autism or intellectual disability during their two years of training. This is particularly concerning given that autism substantially increases the risk of having a psychiatric disorder such as anxiety, depression or attention deficit hyperactivity disorder.
The lack of psychiatrists with specific training in autism contributes to misdiagnoses and misguided treatments. A 2012 study found that 60 percent of psychiatric diagnoses among people with autism were no longer supported when the assessment took into account behaviors typically seen in autism, such as insistence on sameness or repetitive rocking.

Friday, October 17, 2014

Autism, Ebola, Vaccines, CDC, and Conspiracy Theory

The Centers for Disease Control and Prevention is a major source for information about autism. If people are less confident about CDC, they might be less inclined to believe that information.  So a seemingly unrelated issue -- Ebola -- could affect autism politics. Even before the outbreak, a now-debunked conspiracy theory held that CDC had covered up evidence of a vaccine-autism link.

CBS reports:
Americans' faith in the agency charged with protecting the homeland from the rapidly escalating Ebola outbreak in West Africa -- which has already crept onto U.S. soil -- has dropped sharply since the crisis emerged.
A CBS News Poll has found that positive assessment of the Centers for Disease Control and Prevention has declined dramatically, with only 37 percent of respondents saying the CDC is doing an excellent or good job -- down from 60 percent in a May 2013 Gallup poll.

The CDC is rated more positively by Democrats (49 percent) than Republicans (35 percent).

Officials from the Obama administration, including the president himself, have acknowledged that missteps were made in the handling of the first confirmed Ebola case diagnosed inside the U.S; a Liberian man who died in a Dallas hospital on Oct. 8
Indeed, at iO9, Mark Strauss reports that anti-vaccine activists are already claiming that the Ebola outbreak is plot to divert attention from the conspiracy.