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Saturday, February 28, 2015

Trump on the Vaccine Schedule

On Wednesday, Donald Trump was a guest on Hugh Hewitt's radio program:
HH: And it goes to a tweet that you put out. I love the fact that you tweet your own stuff. You wrote massive combined inoculations to small children is the cause for a big increase in autism. Spread shots over a long period, and watch positive result. Do you stand by that, Donald Trump?
DT: Okay, I do, and let me explain it real quickly. I am a total believer in getting the shots and having it done, and I am a total believer, 100%, nobody a bigger believer. What I don’t like seeing is that 20 pound little baby going in and having this one massive inoculation with all of these things combined. I’d like it spread over, because look, our autism rate is at a level that it’s never been. Nobody’s ever, you know, in the old days, you didn’t even hear about autism, and now it’s at a level that’s so high, especially in boys, but so high that nobody can even believe it. What I’m saying is 100% I want to see it happen. I want everybody, but it should be spread over. Smaller doses over a longer period of time. So spread it out over a year. There’s no harm in that, and I believe autism will go way down.
HH: So you’re saying there’s a causal connection…
DT: I totally believe, but I would like to see it spread out and in smaller doses.
HH: So you believe there’s a causal connection between vaccines and autism?
DT: Well, a lot of people do. I mean, there are many people that do. And I know at least two people, one of them who works in the building that I’m in right now, a beautiful woman, has a child. The child is 100% healthy, takes the child, who was I think around a year and a half or two years old to get the shot, gets this massive shot of fluid pumped into the baby’s body, and a few days later, catches a fever, and all of a sudden, is severely autistic. And many people, many people have had that experience, Hugh. And I will tell you, on Twitter and on Facebook, where you know, so many people, I feel, it’s sort of interesting, because I get so much response, people are praying for me that I at least say that. So I totally believe in the shot. I totally believe that you should be vaccinated. But let them spread it out over a little period of time. You can’t pump that, because have you ever seen the size of these inoculations? You can’t pump that much fluid into a little baby’s body. And I think it’s having an effect. And I know of at least two cases in my, but many people say the same thing happened to me where their child is totally healthy. They get pumped up with this huge pile of liquid, with many, many different vaccines, and their child turns out to be autistic after it. And all I’m saying is spread it out in smaller doses over a longer period of time.
The Los Angeles Times reports:
"The idea of overloading the immune system is a false concept," said Dr. James Cherry, a UCLA research professor and primary editor of the Textbook of Pediatric Infectious Diseases. "It's absolute misinformation."

In fact, the body reacts to a bacterial infection to the throat far more aggressively than it does to the measles vaccine. The body needs to develop roughly 3,000 antibodies to counteract the 3,000 proteins in a typical strep throat.
The measles-mumps-rubella vaccine, known as MMR, has only about 40 proteins, so the body needs to develop only 40 antibodies to handle the vaccine, from which it learns how to keep the body healthy from measles, mumps and rubella.
Why is a delayed immunization schedule harmful?
Delaying vaccines puts a child at greater risk of contracting diseases that can cause severe illness or death, experts said.

Facilitated Communication and Other Fads That Won't Die

In Evidence-Based Communication Assessment and Intervention, Scott Lilienfeld and colleagues have an article titled The Persistence of Fad Interventions in the Face of Negative Scientific Evidence: Facilitated Communication for Autism as a Case Example."  Excerpts:
Traditionally, fads are defined as short-lived fashions that disappear about as abruptly as they emerged (Best, 2006; Paris, 2013; Vyse, 2005). Nevertheless, the fields of communication disorders, as well as clinical, counseling, school, and educational psychology, have often been bedeviled by a trend that has received scant attention— namely, the propensity of certain interventions to endure in the practice community well after researchers have discredited them (see also Kurzban, 2011, on “zombie psychology,” or erroneous ideas about the mind that will not disappear). In this article,
we examine a recent example of this phenomenon with an eye to better understanding its sources: the persistence and likely resurgence of facilitated communication (FC) for individuals with autism spectrum disorder (ASD) and other developmental disabilities.
Although FC was thoroughly discredited by controlled research by the mid-to-late 1990s, a convergence of evidence from multiple sources, including surveys of use, endorsement by academic and professional institutions, and coverage in the popular media, demonstrates that the FC meme has proven surprisingly resilient to scientific disconfirmation (see also Hagen, 2012). As conceptualized by Dawkins (1989), a meme is a unit of cultural transmission akin to a gene. Like many other memes, FC has survived in part by adopting new names (e.g., supported typing, assisted typing) or by mutating into newvariants (e.g., rapid prompting, informative pointing) in response to environmental changes (Gabora, 1996), such as adverse publicity. Indeed, the propensity of ineffective interventions to undergo only superficial rather than substantive changes in response to negative evidence is a frequent hallmark of pseudoscientific techniques, most of which lack the self-correcting property of scientific techniques (Finn et al., 2005; Lilienfeld et al., 2014).
  • Best, J. (2006). Flavor of the month: Why smart peoplefall for fads. Berkeley, CA: University of California Press.
  • Dawkins, R. (1989). The selfish gene. Oxford: Oxford University Press.
  • Finn, P., Bothe, A. K., & Bramlett, R. E. (2005). Science and pseudoscience in communication disorders:Criteria and application. American Journal of Speech-Language Pathology, 14, 172–186.
  • Gabora, L. (1996). A day in the life of a meme. Philosophica, 57(1), 53–90.
  • Hagen, K. L. (2012). Speechless: Facilitated communication, a long-debunked pseudoscience, makes asurprising return. Skeptic, 17, 14–19.
  • Kurzban, R. (2011, February 2). Zombie psychology:Bad ideas that simply refuse to die. The EvolutionaryPsychology Blog.  
  • Lilienfeld, S. O., & Arkowitz, H. (2014). Why “just sono” doesn’t work. Scientific American Mind, 25,60–61.
  • Lilienfeld, S. O., Lynn, S. J., & Lohr, J. M. (2014). Scienceand pseudoscience in clinical psychology (2nd ed.).New York, NY: Guilford.
  • Paris, J. (2013). Why is psychiatry prone to fads?Canadian Journal of Psychiatry, 58, 560–565.
  • Vyse, S. (2005). Where do fads come from? In J. W.Jacobson, R. M. Foxx, & J. A. Mulick (Eds.), Controversialtherapies for developmental disabilities: Fad, fashion,and science in professional practice (pp. 19–30).Mahwah, NJ: Erlbaum.

Friday, February 27, 2015

Georgia: Pay Now or Pay Later

In Atlanta, WABE reports:
A popular state Senate bill requiring private insurers to cover autism treatment for young children was scrutinized Wednesday by members of a House committee. Representatives don’t want small businesses to pay more for insurance.
Under the bill, insurance companies would have to cover autism treatment coverage for children six years old and younger. Insurance Committee Chairman Richard Smith, R-Columbus, says small businesses can’t afford the extra costs.
“How do I go back home and say by the way, we just voted to raise your insurance premium,” Smith says.
But Sen. Charlie Bethel, R-Dalton, says the costs for taxpayers is much higher without the treatment because studies show early autism intervention is successful. He says it’s more expensive to educate in a special needs classroom versus a regular one.
“If that business is in that precarious of a financial position, I kind wonder whether they’re going to be able to pay their property taxes when all these children show up in elementary school and cost the district an extra $10,000, $12,000, $14,000 per year,” Bethel says.

Thursday, February 26, 2015

Neurodiversity and Cure

Elizabeth Picciuto writes at The Daily Beast:
“The idea of a cure for autism doesn’t make sense. Autism isn’t a disease or an injury; it’s a neurodevelopmental disability that shapes our brains differently,” Julia Bascom told me via email. Bascom is director of programs for the Autistic Self-Advocacy Network, or ASAN, an advocacy organization run by and for autistic people.
She continued, “If I can’t talk, does it make sense to look for a pill for that, or should my speech therapist help me learn how to type or sign instead? Is flapping my hands or intensely and obsessively loving something ‘weird’ or wanting to be by myself the psychological equivalent of diabetes, or is it a natural and beautiful part of human diversity?”

Just as homosexuality used to be seen as a disorder but is now accepted as part of the range of human diversity, a neurodiversity proponent sees the classifying of autism as a disorder as a socially intolerant mistake. C.M. Lim is a research associate at the Centre for Biomedical Ethics, National University of Singapore who just published a paper on the debate between treating and accommodating autism in the journal Bioethics. He thinks autism and homosexuality are fundamentally disanalogous in this way.
“[Until] the 1970s, because of then-prevalent theories of homosexuality, it remained an important factual matter whether homosexuality was in fact associated with being defective in other areas of everyday life, including social effectiveness. It was important for members that they were in fact equally socially effective as heterosexuals. The neurodiversity claims do not assert for equal social effectiveness, but rather that autistics can be socially effective if society changes to accommodate their differences,” Lim told me in an email. “Also, what is practically involved in accommodating gay people and autistics differ significantly.”
The article links to this study:
 Dev Psychol. 2013 Jan;49(1):59-71. doi: 10.1037/a0028353. Epub 2012 Apr 30.
Deficit, difference, or both? Autism and neurodiversity.
Kapp SK1, Gillespie-Lynch K, Sherman LE, Hutman T.

The neurodiversity movement challenges the medical model's interest in causation and cure, celebrating autism as an inseparable aspect of identity. Using an online survey, we examined the perceived opposition between the medical model and the neurodiversity movement by assessing conceptions of autism and neurodiversity among people with different relations to autism. Participants (N = 657) included autistic people, relatives and friends of autistic people, and people with no specified relation to autism. Self-identification as autistic and neurodiversity awareness were associated with viewing autism as a positive identity that needs no cure, suggesting core differences between the medical model and the neurodiversity movement. Nevertheless, results suggested substantial overlap between these approaches to autism. Recognition of the negative aspects of autism and endorsement of parenting practices that celebrate and ameliorate but do not eliminate autism did not differ based on relation to autism or awareness of neurodiversity. These findings suggest a deficit-as-difference conception of autism wherein neurological conditions may represent equally valid pathways within human diversity. Potential areas of common ground in research and practice regarding autism are discussed
As the study forthrightly acknowledges, however, the sample was self-selected, so the results are not necessarily representative of opinion among autistic or non-autistic people.

More on a Journal Controversy

Paul Jump reports at Inside Higher Ed:
A senior psychology professor has strongly denied any wrongdoing after a blog highlighted what it claimed was his high self-citation rate in papers published in journals he edited.
Johnny Matson, a professor at Louisiana State University and an expert in autism, was the founding editor in chief of the Elsevier journals Research in Developmental Disabilities (RIDD) and Research in Autism Spectrum Disorders (RASD).
Earlier this month the journals came to the attention of Dorothy Bishop, professor of developmental neuropsychology at the University of Oxford. Bishop learned that she was on the editorial board of RASD, although she said that she had no recollection of agreeing to such a position. According to Matson, Bishop did give her permission to be added to the board.
Bishop then looked into the journals, setting out her resulting claims in a blog posting, including that Matson is an author on more than 10 percent of the papers published in RASD since the journal was established in 2007. At around that time his citation count also began to shoot up (according to the Scopus database, he has published 117 papers in RASD and 133 in RIDD, founded in 1987).
Bishop also claims that, according to Thomson Reuters’ Web of Science, just over half of Matson’s citations are self-citations -- much higher than the rates of other autism experts she looked at.
In a comment on the blog post, Michael Osuch, publishing director for neuroscience and psychology journals at Elsevier, insisted that under Matson’s editorship all papers in both journals were reviewed, and that his own were handled by one of the journals’ associate editors. He added that Matson and all associate editors stepped down at the end of 2014

Wednesday, February 25, 2015

Suspension Data

Christina Samuels writes at Education Week:
Eighteen percent of secondary students with a disability served an out-of-school suspension in 2011-12, according to data collected by the U.S. Department of Education, but behind that number are enormous variations in suspension rates at the district and state level.
A civil rights advocacy group's analysis of the data released Monday shows that Florida, at 37 percent, leads all other states in suspending students with disabilities at the secondary level. Florida also led the nation that year in suspensions overall, both at the elementary and secondary level, at 5 percent and 19 percent, respectively, said the Center for Civil Rights Remedies.
The state with the lowest suspension rate for secondary students with disabilities was North Dakota, at 5 percent, said the group, a part of the Civil Rights Project of the University of California, Los Angeles. (We've requested comment from Florida and will add it when we get it.) [UPDATE(4:40 p.m.): Cheryl Etters, the spokeswoman for the Florida Department of Education, said in an email that "decisions regarding discipline policies as well as student suspensions are made at the district level." She deferred to individual districts for any information on their suspension policies.]

Tuesday, February 24, 2015

Virginia Committee Votes to Raise Age Cap in Insurance Mandate

Jacob Geiger reports at The Richmond Times-Dispatch:
Members of the powerful Senate Commerce and Labor Committee on Monday unanimously backed a bill that could help 5,000 Virginia children receive health insurance coverage for autism treatments.
Del. Thomas A. “Tag” Greason, R-Loudoun, sponsored House Bill 1940. The measure would require health insurers, health care subscription plans and health maintenance organizations to provide coverage for the diagnosis and treatment of autism spectrum disorders in children ages 2 to 10.

The bill passed the House this month on a 63-35 vote. Virginia is one of 38 states that require health insurance plans to cover autism treatment.
After the committee vote, Greason told supporters of the bill that he expects it to quickly receive Senate approval. Because of the amendment, the bill must be approved again by the House of Delegates. Greason said he did not anticipate any problems getting that approval before the Assembly session ends this weekend.
Four years ago the delegate sponsored a bill that led to the current law which mandates coverage for children age 2 to 6.
Autism Speaks, an advocacy group for children with autism and their families, said the extension in coverage is needed because the average age for diagnosis in Virginia is 6 to 7.

Monday, February 23, 2015

Stan Lee

A number of posts have discussed autism and popular cultureFrom
Stan Lee is best known for his writing skills, not his artistic skills. However, that fact didn’t stop the Marvel Comics legend from drawing Spider-Man for an eight-year-old autistic boy, who is a big fan of the character.
According to the New York Times, one of Stan Lee’s neighbors approached him about drawing a Spider-Man picture for eight-year-old Jamel, after reading an article about him. Jamel has autism, and he didn’t speak until he was in preschool. Jamel recently celebrated his eighth birthday with a huge Spider-Man party.
“This was a unique experience,” explained Lee. “Corky [Lee's neighbor] called me and said there was a little boy. She wanted a sketch, so I did one.”
Lee also quipped, “I’m not known as an artist, which is lucky for the world.”
Lee’s neighbor then mailed the sketch to a New York Times reporter, who delivered the framed sketch to Jamel in his family’s East Harlem apartment.

Sunday, February 22, 2015

Assisted Suicide

Elizabeth Picciuto writes at The Daily Beast:
In many articles on the topic, such as this one, the only opposition to assisted death mentioned is religious opposition. However, many disability-rights advocates are extremely concerned about the increasing societal approval of assisted death, and oppose it for entirely secular reasons.
Samantha Crane is the director of public policy at the Autistic Self-Advocacy Network. Crane recently lost her grandmother, who had Alzheimer’s disease. While Crane mourns her loss, she doesn’t view her grandmother’s final days as a tragic decline or a fall from the dignity of her earlier days. “She didn’t remember a lot of things, but every day she woke up, she was happy,” Crane told me. “She was dignified. I want to reclaim the term ‘dignity.’”
The Autistic Self-Advocacy Network is one of several disability-rights organizations that opposes legal physician-assisted death.
Supporters of physician-assisted death argue, however, that it’s a matter of freedom of choice whether people live or die. They say that no one should die without dignity, that sometimes life is too painful or difficult to be worth living. Thus compassion should compel us to aid someone suffering, and who has a terminal illness, to end their lives. The leading right-to-die organization, Compassion and Choices, did not reply to an emailed request for interview by the time of publishing.
Disability-rights advocates, on the other hand, are concerned that there is a double standard. Suppose a good friend of yours says that she wants to kill herself. You, and most people others close to her, would probably try to help her so she did not feel that suicide was a viable option. Suicide prevention would be the goal of the medical profession, of family and friends. Not, however, in the case of someone seeking physician-assisted death.
“The difference is your health or disability status. Then suddenly suicide is a rational decision,” Diane Coleman, president and CEO of Not Dead Yet, a disability-rights group that advocates against assisted suicide and euthanasia, told The Daily Beast. “We think equal rights should also mean equal rights to suicide prevention.”
Of course, someone who supports the right to legal assisted death would stress that it is in cases of terminal illness and pain, and not disability, in which they wish to allow people the right to die. Disability- rights advocates, however, think this can be misleading because prognoses can so often be mistaken.
“A lot of people say this is not about people with disabilities, this is about terminal prognoses,” said Crane. “Yet the disability community is filled with people who have outlived a six-month prognosis for years.”

Saturday, February 21, 2015

Bleach as "Cure"

Tom Boggioni reports at Raw Story:
According to If You Only News, parents have turned to Miracle Mineral Solution (MMS), containing sodium chlorite which is mixed with citric acid (i.e. orange juice) to make chlorine dioxide. According to the promoters, the solution, which can be taken orally or administered via an enema, can cure HIV, malaria, hepatitis, autism, acne, and cancer.
Miracle Mineral Solution is the brainchild of Jim Humble, who quit the Church of Scientology to form the Genesis II Church of Health & Healing in order to promote his “miracle” cure in Africa and Mexico.

The Food and Drug Administration disagrees with Humble’s claims and has posted a warning on their website calling the product “dangerous” and “potentially life threatening,” advising “drinking the amount recommended on product labels can cause nausea, vomiting, diarrhea, and symptoms of severe dehydration.”
Additionally, the Environmental Protection Agencywarns that chronic exposure to small doses of chlorine dioxide could result in reproductive and neurodevelopmental damage, and the Occupational Safety and Health Administration has issued guidance in the use of chlorine dioxide in the workplace

Friday, February 20, 2015

Special Ed Options for Parents

A Tuesday release from Senator Bob Casey (D-PA):
Today, U.S. Senator Bob Casey (D-PA) announced that he has introduced legislation that would allow parents of a child with a disability to access more information about their educational options to ensure that those with a disability don’t miss out on the opportunity to achieve a high school or college degree. The legislation, the Empowering Parents & Students Through Information Act, would seek to clear up often confusing state guidelines and empower parents to make more informed decisions about which education track is best for their child with a disability.
“Deciding which educational track to place a child with a disability on is one of the most consequential decisions a parent can make,” Senator Casey said. “As parents make these decisions it’s critical that they have all the information necessary to make the best choice for their child. Those with disabilities have a lot of ability. We owe it to these children to do everything possible to ensure they can achieve their dreams and live full lives.”
The Empowering Parents & Students Through Information Act helps ensure that America’s six million students with disabilities and their families have access to necessary information to make informed decisions on their child’s education and future opportunities for pursuing college and career goals. The bill is also cosponsored by Senator Patty Murray (D-WA) who is the leading Democrat on the Senate’s Health Education Labor and Pensions (HELP) Committee.
This Act:
  • Clarifies that States Must Establish Clear Guidelines to Help Educators & Parents Make Informed Decisions About the Appropriateness of Students Being Placed on an Alternate Standard and Taking an Alternate Assessment Based on Alternate Achievement Standards (AA-AAS): In many states, students with disabilities who are placed on an alternate standard and take an AA-AAS are taken off-track from receiving a regular high-school diploma because they are unable to meet graduation requirements. This legislation ensures that States provide the necessary guidelines for parents and educators to help in their decision making for determining when it is appropriate for a child to take an AA-AAS.
  • Empowers Parents as Partners: This legislation ensures that parents are actively involved in the decision for their child to be assessed using an AA-AAS. The legislation makes clear that parents must give informed consent and be made fully aware of the impact on the child of taking the AA-AAS and on their child’s eligibility to receive a regular high school diploma.
  • Holds High Expectations for Students: This legislation promotes greater access to the general curriculum and reinforces the use of accommodations to increase the number of students with the most significant cognitive disabilities who participate in and are assessed on grade-level academic instruction.
  • Protects Against the Misuse of Assessments: This legislation helps ensure that the AA-AAS is appropriately given only to students with the most significant cognitive disabilities, as decided by parents and educators on an annual, individual and subject-by-subject basis. Further, this legislation prevents a student’s Individualized Education Program (IEP) from being used for accountability purposes.
  • Provides Public Transparency: This legislation allows parents, educators, policymakers and stakeholders to know how many students were assessed using the AA-AAS on State and local educational agency (LEA) report cards, data that is already provided by schools and districts to the State but not readily available on state/LEA report cards.
This legislation is supported by: ACCSES, Association for People Supporting Employment First, Association of University Centers on Disabilities, Autism National Committee, Council of Parent Attorneys and Advocates, Decoding Dyslexia – Pennsylvania, Easter Seals, National Disability Rights Network, National Down Syndrome Congress, National Down Syndrome Society, TASH, The Arc, The National Center on Learning Disabilities, Tourette Syndrome Association

Thursday, February 19, 2015

State Legislatures, Restraint and Seclusion

At Education Week, Christina Samuels reports:
After years of sometimes-disappointing efforts in Congress, activists—including advocates for people with disabilities—are finding state legislatures fertile ground for fighting against the practice of restraint and seclusion in schools.
In recent weeks, Virginia lawmakers have voted in favor of regulations that would restrict the behavioral-modification tactics, replacing what had been "informational" guidance that placed no mandate on schools. Other states that have imposed restrictions recently include Hawaii, Massachusetts, and Ohio. More than 20 states have restrictions around restraint and seclusion for all students, according to one advocate's tally.
"In varying levels, there's probably some group in every single state working on [restraint and seclusion]," said Eric Buehlmann, the deputy executive director for public policy for the National Disability Rights Network in Washington.
Not all bills are successful. In Mississippi, a bill to restrict the practice did not make it out of the legislature last year. And some education groups oppose the restrictions. For example, AASA, the School Superintendents' Association, has argued that policy should not be built around rare, inappropriate uses. Used properly, restraint and seclusion can be tools to keep school staff and other students safe, the organization argues.
The Virginia Association of School Superintendents opposed the legislation in that state, saying that districts will have to bear the costs of training personnel in other behavioral management techniques.
"We consider this an unfunded mandate on the part of the General Assembly," said Howard B. "Ben" Kiser, the executive director of VASS. "We're more than happy to work with the state board over the next several months to establish fair and appropriate regulations, but the training [costs are] still there."
Among the challenges in restricting the practice is that restraint and seclusion incidents are not well reported. The news organization ProPublica, which has been investigating restraint and seclusion abuses in schools, noted in a recent report that the 1 million-student New York City school district reported zero instances of restraint in the 2011-12 school year, as did Chicago, Los Angeles, and other districts.

Wednesday, February 18, 2015

Autistic Man v. Neurodiversity Movement

At Newsweek, Erika Hayasaki profiles Jonathan Miller, an autistic man who supports the search for a cure.
At 59, Mitchell easily admits that he is lonely. He walks with heavy shoulders, and a facial expression that is part grin, part grimace. His social life revolves around weekly dinners with his parents, both in their 80s. He can’t keep a job. He can’t find a girlfriend. He paces, obsesses, repeats himself and sometimes doesn’t realize when he’s saying something rude. Mitchell blames it all on his autism. “I hate it,” he says. “It’s a horrible disability. I wish there were a cure.”
He has reiterated those three sentences on the Internet many times, in many ways, and his unapologetic, blunt stance has made him one of the most controversial voices in the autism blogosphere—he’s one of the few who have shown outspoken support for the effort to find a cure. “Hopefully on my tombstone they will write, ‘We don't need no stinkin’ neurodiversity,’” Mitchell writes, taking a direct shot at the growing movement for acceptance and inclusion for people with everything from Asperger’s to attention deficit disorder, epilepsy and Tourette’s syndrome.
When it comes to the question of whether and how to “treat” autism, many neurodiversity advocates try to make a fine distinction: Remedies that aim to relieve suffering are OK, but the idea of a “cure” is repellent. Many believe, as autistic educator and author Nick Walker puts it, that the effect of a cure would be “the reduction of naturally evolved human diversity.”

Tuesday, February 17, 2015

Questions About Journals

At Discover, "Neuroskeptic" writes about editorial standards of two scientific journals.
The journals are called Research in Autism Spectrum Disorders (RASD) and Research in Developmental Disabilities (RIDD). Both publications are owned by Elsevier, and they have the same Editor-in-Chief, Johnny L. Matson. Or at least they did until recently. Matson may have been removed – although it’s not clear if there is a replacement for him.
The scandal emerged some weeks ago after Oxford University researcher Dorothy Bishop emailed RASD to say that she had concerns about the journal. Bishop asked to be taken off their editorial board. Instead of just Bishop’s name being removed, however, all information about the editors disappeared from the websites of both RASD and RIDD. Overnight they became, as Bishop put it, Journals Without Editors.
Matson is an autism researcher and much of his work concerns the diagnosis and evaluation of this disorder. Over the years Matson has developed over a dozen questionnaires and other rating scales, ranging from the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) to the Profile of Toileting Issues (POTI).
All of these instruments are sold via a company called Disability Consulting, LLC, based in Baton Rouge, Louisiana. The listed contact email address is for one Dean Matson, who’s also the Director. The only products listed on their website are Matson assessment tools. They cost up to $325.00 per kit (each kit includes 50 score sheets.)

Monday, February 16, 2015

Consume More Red Meat and Milk?

This article is not from The Onion.  It is in The High Plains Journal.  Farmer Trent Loos writes:
Autism is on the rise in this country. Because junk science led so many parents to opt out of vaccinating their children for fear of autism, we now have a bigger problem with diseases like measles that were once basically eradicated. That is why we cannot take issues like this lightly.
So far, so good. Then...
Arthur Beaudet, chair of molecular and human genetics at the Baylor College of Medicine and a physician at Texas Children’s Hospital, is the senior author of the report that appears online in the Proceedings of the National Academy of Sciences.
The findings suggest that dietary intake of red meat, especially among very young children, could reduce the chance of developing autism. Additionally, a study from Egypt showed a clear improvement in the mental and physical symptoms of the disease in autistic children who consumed higher levels of L-carnitine.
Meat eaters receive about 75 percent of their carnitine from their diet. However, dietary carnitine levels are low in vegetarians and particularly in vegans. In most people, levels of carnitine are balanced by the body’s ability to manufacture its own carnitine in the liver, kidney and brain, starting with a modified form of the amino acid lysine.
If you compare the dramatic increase in autism to the marked decline in meat and milk consumption during the last 10 years, it certainly gives one cause for concern that our diet is likely leading to increased autism. Are parents finally going to have to take responsibility for giving their children this horrible disease because they were trying to follow some ridiculous Hollywood trend?
There are some problems here.  First, what Beudet found was a correlation between autism and a certain genetic abnormality associated with the synthesis of carnitine. Even if subsequent research confirms the findings, correlation is not causation, and they do not suggest anything about the consumption of red meat.  In any case, the whole thing makes so sense. Autism shows up in infancy, and infants have never consumed a lot of red meat.  (Toothless two-month-olds cannot chow down on steak.) The last paragraph above is a classic of the post hoc, ero propter hoc fallacy.  One can also correlate the rise of autism with, say, the closure of Radio Shack stores.

And needless to say, self-advocates would take exception of the characterization of autism as a "horrible disease."

Sunday, February 15, 2015


At The Huffington Post, Carrie Cariello writes about dilemmas:
You can see my dilemma. If I start running around declaring autism an epidemic and screeching about how we need to find out where it's coming from and who started it and how to cure it, well, that sort of contradicts the whole message of acceptance and tolerance and open-mindedness.
This fragile glass house we've been working so hard to build over the past decade will explode into a thousand tiny pieces.
But on the other hand, it sort of is an epidemic. Other families are going to have babies and maybe they would like to have some idea of how to prevent this tricky spectrum disorder from striking. My own children will have their children, and if autism is indeed caused by automotive exhaust, it would be good to know so we could all buy electric cars.
At the same time, I don't want to focus so much on the what and when and where and how that I forget about the who.

Saturday, February 14, 2015

What We Don't Know About Employment Support and Other Services

Paul T. Shattuck and Anne M. Roux write at Autism:
The authors of “Vocational support approaches in autism spectrum disorder: A synthesis review of the literature” have written a commendable review that finds a very weak academic evidence base about employment supports. Although the majority of a typical lifetime is spent in adulthood, we know the least about this stage of life—by far—when it comes to autism spectrum disorders (ASDs).
The authors make thoughtful suggestions for advancing this important area of research. We wish to offer complementary ideas rooted in life course and public health perspectives. These perspectives shift the focus of attention from the individual to the social level of analysis, shine light on measurement ideas seldom discussed in employment intervention research, and offer a set of research approaches that could help advance this area of inquiry.
In contrast to the dearth of research on vocational supports, many ASD program innovations are happening outside of academia (Autism Speaks, 2012). An outpouring of grassroots efforts and billions of public dollars for services each year aim to foster better outcomes for those affected by autism. In real-world settings, the problem is less about a shortage of effort than a shortage of processes for learning from effort. Our ability to meaningfully measure efforts and outcomes at program and population levels is woefully underdeveloped.
Imagine if a large corporation tried to operate without financial statements—without a clear picture of sales, expenditures, customer satisfaction, or assets. The company would quickly go under. Yet, this state of affairs is commonplace in many autism services. At a population level, we are almost completely unable to clearly describe the resources expended on services or measurable indicators of the population outcomes we hope to influence—including the employment rate.
Tracking sales and inventory, mining “Big Data,” visualizing performance indicators with data dashboards, and the huge toolbox of measurement approaches used in continuous quality improvement practices are transforming the landscape of business and health-care administration around the world. Wise organizations invest in creating measurement feedback loops to learn from experience in ways that help improve future performance.
We need a corresponding measurement revolution for ASD services, including employment supports. An abundance of opportunities exist for collaborating with community agencies to create practice-based evidence. Scientists with advanced training in measurement and analysis methods are uniquely positioned to be useful in this endeavor.

Friday, February 13, 2015

SD Autism Mandate Advances

In Pierre, SD, the Capital Journal reports:
The state Legislature has taken another step toward mandating that South Dakota’s health insurance industry cover certain therapies for autistic children.

The Senate on Wednesday passed Senate Bill 190 which seeks to require all health insurance plans sold in the state except those sold on the Affordable Care Act insurance marketplace, to cover Applied Behavior Analysis, or ABA, therapy. The therapy has been shown to drastically improve outcomes for children with autism spectrum disorders, said Parents for Autism Insurance Reform South Dakota lobbyist Lisa Stanley, whose son is autistic.
“If you treat these kids early and intensively, you can change their lives,” Stanley said.

Stanley’s son, Christian, was able to join a regular kindergarten class last fall thanks mainly to ABA therapy, she said.

Thursday, February 12, 2015

The Autism Job Club

Many posts have discussed public and private efforts to encourage employment of autistic adults.

At Fox and Hounds, Michael Bernick writes:
This week The Autism Job Club is being published (book’s website). Richard Holden, Bureau of Labor Statistics (BLS) Regional Commissioner and I are the authors. Much of the book focuses on employment initiatives in California, especially a job club for adults with autism that we have been involved with in the Bay Area.
When I started in California’s autism community 24 years ago, autism was a little-known and little-discussed condition. Today, it is impossible to pick up a newspaper or book, or turn on the television, or go to the movies without an autism reference.
However, despite the heightened autism presence in public consciousness, the employment situation of adults with autism in California and nationwide has changed little. In the early 1990s, the unemployment rate among adults with autism was estimated at over 65%. Today, the unemployment estimates are as high or higher.
In the book we discuss the dynamics of this high unemployment rate. Chief among these dynamics are the heightened competition for all jobs and changing structure of employment, the sharp rise in government disability rolls, and the failure of several highly touted government initiatives, particularly the Ticket-to-Work, to have any significant impacts.
The book focuses on collective and individual efforts to increase employment of adults with autism. These are the efforts to place adults with autism in tech positions—including Ultra Testing, SAP, and Specialists Guild. They are the small businesses targeting adults with autism, such as the Rising Tide Car Wash, Roses for Autism, and the Agricultural Communities for Adults with Autism; and they are the larger businesses, such as Walgreens and Best Buy with autism initiatives. Most of all they are the art of the autism job coach, the understanding of the job placement techniques applicable to all workers and how these are tailored and taken up by adults with autism

Wednesday, February 11, 2015

Problems of Autistic Adults

At Science News, Siri Carpenter writes:
Spend time talking with autism researchers or with families of adolescents or adults with autism, and it doesn’t take long for the phrasefalling off a cliff” to come up. The new environments, people and expectations for independence that come with entry into adulthood can be tricky for any young person. For someone with impaired abilities to communicate and manage relationships, solve problems flexibly and regulate emotions, this period can be harrowing. And the end of adolescence means the end of federally mandated special education services — just when the need for support may be greatest.
In a study of 242 teens transitioning to adulthood, Taylor and Marsha Mailick at Wisconsin–Madison found that young people’s autism symptoms and behaviors such as repetitive habits, withdrawal and self-harm often improved during adolescence. But progress typically slowed markedly, or even stopped, after students left high school.
Paul Shattuck directs the Life Course Outcomes program at Drexel University’s Autism Institute in Philadelphia. He has spent much of the last five years dissecting data from a nationally representative survey of adults who received special education services during high school, including students with autism.
Shattuck’s results are bleak. Within just a few years of leaving high school, almost 40 percent of the young adults in his sample were receiving no medical, mental health, case management or speech or language services, he and colleagues reported in JAMA Pediatrics in 2011.
In a separate study published in 2012 in Pediatrics, Shattuck’s team found that more than half of young adults with autism were “completely disengaged” from any employment or post-secondary education in the two years after leaving high school. Young adults with learning disabilities, intellectual disabilities or speech or language impairment were much more likely to have some engagement with work or school after high school.
Poor employment outcomes are especially dismaying because good employment may make a world of difference for autistic adults’ personal development. In a 2014 study, Taylor, Smith and Mailick found that the more independence adults had at work, the more improvement they showed over the next five years in social interactions, communication skills, repetitive behaviors, self-harm, socially offensive behavior and activities such as housekeeping and making meals.
In 2013, a review published in the Journal of Autism and Developmental Disorders of 1,217 studies, conducted from 1950 to 2011, found only 13 that assessed interventions (all psychologically based) for adults with autism. The review, by researchers at the University of Pittsburgh, found that most research followed single cases or involved very few participants. Only four of the studies randomly assigned adults to treatment versus control groups.

Washington State Bill on Screening

State of Reform reports:
This week legislation sponsored by Representative Marcus Riccelli (D-3) moved out of the House Health Care & Wellness committee with nearly unanimous approval from committee members. HB 1365 would ensure children on Medicaid would receive universal screenings for autism as recommended by the American Academy of Pediatrics’ Bright Futures Guidelines, which call for infants developmental screenings to be performed at 9 months, 18 months and 30 months, with autism screenings at 18 and 24 months.
Since 2010, private health plans have been required to comply with the Bright Futures Guidelines. However, children on Medicaid currently qualify for only one developmental screening between 9 and 30 months, while a child under 36 months may be screened for autism only if he or she displays signs of being autistic.
Before it was reported out of committee, Representative Riccelli said of his bill, “Children on Medicaid don’t deserve [to have only] one-fifth of the screenings that those covered by commercial plans [do].”
Proponents of the legislation cite a 2012 report by the Washington State Institute for Public Policywhich indicated that fewer than half of children with developmental delays are identified before starting school. The legislation aims to improve early detection in order to ensure that opportunities for treatment and therapy are not missed.

Medicaid in Connecticut

The Connecticut Post reports that although the state's Medicaid program is expanding coverage, it is also proposing regulatory barriers:
Some provisions of the proposed regulations are unlike those any other state has imposed, according to the national advocacy group Autism Speaks. One requirement – that a caregiver be present or available at all times while treatment is being provided – would discriminate against children of working, single or disabled parents, the group said. And it warned that another provision related to provider qualifications “threatens to virtually gut coverage in Connecticut and deprive Medicaid-eligible children under 21 of medically necessary care in direct violation” of federal obligations.
“There are so many roadblocks here that it’s unlikely for this to allow for the demand to be met,” said Jay Sicklick, deputy director of the Center for Children’s Advocacy, which is affiliated with the UConn School of Law.
In the past, the state Department of Social Services denied Medicaid coverage of applied behavior analysis to families seeking it for their children. But last summer, the federal government made clear that state Medicaid programs must cover medically necessary services for clients under 21 with autism spectrum disorders.At issue is how Medicaid will handle coverage of services for autism spectrum disorders, particularly applied behavior analysis, a treatment that is considered effective but is also intensive – providers often recommend 30 to 40 hours of therapy per week – and costly.
DSS has projected that the coverage would cost $28.1 million in the next fiscal year, half of which would be reimbursed by the federal government. Although the regulations are not finalized, the coverage took effect Jan.1.

Mississippi Mandate Moves Forward

In Jackson, Mississippi, Emily Le Coz writes at The Clarion-Ledger:
Legislation extending autism insurance coverage to children passed the Senate floor on Thursday despite heated opposition by a handful of Tea Party conservatives.
Senate Bill 2581 won the vote by 39-6. It requires health insurance policies to offer coverage for autism treatment like Applied Behavior Analysis for children ages 2-8. It also regulates the practice of ABA therapy and requires providers obtain state licenses.
Some, though, argued the state shouldn't tell private insurers what to cover and questioned why autism should get special recognition. Led by state Sen. Chris McDaniel, R-Ellisville, opponents took turns grilling the bill's main sponsor for roughly a half hour.
They asked why the state shouldn't also mandate health insurers cover obesity, diabetes and Attention Deficit Disorder. They asked why not let the free market decide for itself what to cover. And they likened the measure to Obamacare.
"This is totally getting out of hand," said state Sen. Rita Parks, R-Corinth, who introduced the bill on the floor, after a round of such questions.
McDaniel said he cares about children with autism and agreed the state should do something, but said SB 2581 takes the wrong approach.
State Sen. Will Longwitz, R-Madison, wasn't buying it.
"I would ask you today if we're going to have an ideological battle," he said, "let's not do it at the expense of children with autism."

Is 2015 the Year for a Hawaii Mandate?

The Honolulu Star-Advertiser reports (via Insurance News Net):
After years of trying, advocates for children with autism are hopeful that the Legislature will pass a bill requiring medical insurance companies to provide coverage for diagnosis and treatment.

Hawaii is one of only 12 states that do not require health insurance coverage for children with autism, said Lorri Shealy Unumb, vice president of state government affairs for the national advocacy group Autism Speaks.

"I think the states are realizing that this is a fiscal and moral imperative," Unumb, the mother of an autistic child, said at a joint hearing of the Senate Health and Commerce and Consumer Protection committees Friday.

The two committees moved out Senate Bill 791, which requires health insurers, mutual benefit societies and health maintenance organizations to provide coverage for autism diagnosis and treatment for children until age 11 and a total lifetime maximum benefit of about $220,000.

Senate Health Chairman Josh Green (D, Naalehu-Kailua-Kona), who introduced the bill, said parties from the health insurance industry and the advocacy groups worked with him to reach a compromise after a similar measure died in the closing days of the 2014 Legislature.

"I really believe that this is the year that it's going to pass," he said after Friday's hearing.

Tuesday, February 10, 2015

Vaccine Attitudes

The Pew Research Center reports:
An 83% majority of the public says vaccines for diseases such as measles, mumps and rubella (MMR) are safe for healthy children, while about one-in-ten (9%) think such vaccines are not safe. An additional 7% volunteer that they don’t know.
Majorities across virtually every demographic and partisan group view the vaccines as safe. However, there are some differences in attitudes, with less educated people and younger adults more likely to say they are not safe.
The new national survey by the Pew Research Center, conducted Feb. 5-8 among 1,003 adults, finds Republicans (89%) and Democrats (87%) generally agree that such vaccines are safe for children who are healthy.
Roughly nine-in-ten college graduates (92%) see vaccines for MMR as safe for healthy children. This view is somewhat less widespread among those with some college experience (85%) or a high school degree or less (77%).
Three-quarters or more in every age group say vaccines for MMR are safe. However, among adults 50 and older, 90% express this view, compared with 77% of adults 18-29 and 81% of those 30-49.
A separate Pew Research Center survey of opinion among the public and scientists about science and society found widespread support for requiring childhood vaccinations: 68% of the public said children should be required to be vaccinated, while 30% in that survey said parents should be able to decide not to vaccinate their children. Young adults were more likely to say vaccinations should be a parental choice, while there was no significant difference in attitudes based on education.

Monday, February 9, 2015

Autism Speaks and a New Statement on Immunizations

Michelle Diament reports at Disability Scoop:
Amid concerns about measles, the nation’s largest autism advocacy group has updated its stance on vaccines and autism, but remains mum on whether it will fund further studies on the issue.
Autism Speaks revised its policy on immunizations in a statement published on its website last week.
“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. We urge that all children be fully vaccinated,” reads the statement from Rob Ring, the group’s chief science officer.
The language replaces a four-paragraph statement on the issue which had been in place since April 2013. The organization’s previous position also strongly encouraged parents to vaccinate but said “it remains possible that, in rare cases, immunization may trigger the onset of autism symptoms in a child with an underlying medical or genetic condition.”

Is Putin as Aspie?

At Politico, Mark Lawrence Schrad -- the father of a child with Asperger's -- correctly demolishes a Pentagon report suggesting that Putin is an Aspie:
[The] report asks us to believe that all of Putin’s political decisions and inclinations are singularly influenced by Asperger’s: his impatience, his wonkish attention to detail, his comfort with routine, his obsession with controlling the day-to-day operation of running a giant country, his “basic personal struggle” to find an inner circle he can trust, seeking glory for himself and the country he leads—all of it because of something that may or may not have happened when young Volodya was a child. This explanation overlooks the tomes of research in sociology, history, political science and Russian studies suggesting that such traits are all manifestations of the sistema of high-level autocratic politics in Russia—before Putin, under Putin and will continue after Putin—regardless of whether he has Asperger’s or not.
It is not just Putin who gets further denigrated in all of this—it is those of us in the special-needs community, too. Sticking through the jargon of this Pentagon report is hurtful, unscientific and downright condescending terminology describing not just the Russian president, but individuals with Asperger’s and autism worldwide: “suffering” the “neurological insult” and “profound handicap” of Asperger’s, Putin is at a “primitive,” “pre-mammalian” and “reptilian stage of development.” Honestly, it’s so thoroughly insulting, the Pentagon should be ashamed to have paid for it.

And ultimately: So what? If, in the end, it turns out that Vladimir Putin is an Aspie—what does it matter? Can someone with Asperger’s not run a country? Certainly it’d be preferable if the Russian Federation were an actual, functioning, democratic federation, with decision-making power spread throughout the system—but it’s not. Russia is—and largely has been—a closed autocracy with most of the levers of power housed in the Kremlin. In that situation, it might actually be preferable to have someone who’s wired to be obsessively dedicated to the work of governance

The Pentagon study said that it would not be possible to diagnose Putin definitively without a brain scan.  This suggestion indicates a remarkable ignorance:  it is not yet possible to diagnose ASD reliably with brain scans.

Sunday, February 8, 2015

Update and Restraint and Seclusion

Christina Samuels writes at Education Week that the Virgina Legislature has passed legislation to regulate restraint and seclusion and that a Connecticut report says that schools and teachers need more guidance on handling student behavior.
The Virginia legislation requires the state board of education to adopt a policy consistent with the Education Department's guidance on restraint and seclusion. That document outlines 15 principles for schools to follow, including making every effort to restrict the use of restraint and seclusion; a ban on mechanical restraints or chemical restraints; notifying parents each time their child is restrained or secluded, and never using restraint or seclusion for punishment or discipline, coercion, or as a convenience.

The bill passed the Virginia House unanimously on Thursday; a Senate version with the same language passed Jan. 27 on a 35-4 vote. The Associated Press reported that Gov. Terry McAuliffe, a Democrat, supports the legislation.

In Connecticut, the state's child advocate, Sarah Eagan, issued a "call to action" on restraint and seclusion, saying that the practice traumatizes children and does not have any therapeutic value. Over the past three years, 1,313 incidences of a child being injured while being restrained or secluded have been reported, with more than two dozen of those injuries considered "serious," said the report, which was released on Wednesday
From the Connecticut report:
In Connecticut, children with Autism Spectrum Disorders (ASD) are the most likely children to be restrained or secluded in school. Experts have strongly cautioned against reliance on seclusion and restraint for children and adults with Autism. In 2011, the Interagency Autism Coordinating Committee (IACC), authorized under federal law as an advisory committee per the Combating Autism Act of 2006 (P.L. 109-416), issued a public letter to the U.S. Department of Health and Human Services outlining significant concerns regarding the pervasive use of restraint and seclusion for children with autism. The IACC—chaired by Thomas Insel, M.D., Director of the National Institute of Mental Health—stated:
[U]tilization of restraint or seclusion should be viewed as a treatment failure that exacerbates behavioral challenges and induces additional trauma.
In its letter, which specifically addressed seclusion and restraint in schools, the IACC endorsed numerous recommendations for federal agencies including regulatory reform, improved data collection, guidance and technical assistance for providers, concluding:
“[F]ederal legislation is urgently needed to ensure the safety of all students and staff” by requiring standards for monitoring and enforcement of restraint and seclusion practices, as well as prohibition of mechanical, chemical, and high-risk physical restraints . . . “the use of seclusion and restraint in every setting is a critical issue for people with ASD and other disabilities and their families that requires immediate Federal attention.” xiv

xiv IACC (Interagency Autism Coordinating Committee) Letter to the Secretary on Seclusion and Restraint, Sept. 7, 2011, (last visited Jan. 29, 2015).

Saturday, February 7, 2015

Autism and Vaccines

From Autism Speaks:
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. We urge that all children be fully vaccinated.
Rob Ring
Chief Science Officer, Autism Speaks
Who is behind groups such as Generation Rescue and the National Vaccine Information Center? LBRB reports:
CNN Money has a short video up that makes a point that a few of us have been making for the past few years: much of the vaccine antagonistic message is funded by a few wealthy people. A good discussion can be found at A Snapshot of the Deep Pockets of the Anti-Vaccine Movement on Haprocrates Speaks. The CNN piece is called “The money behind the vaccine skeptics“. I can’t get the video to embed here, but one can find it here.
Here’s a screenshot from CNN showing the organizations, people and money that CNN discusses (click to enlarge)

Thursday, February 5, 2015

New Report on Missouri Mandate

Missouri's Department of Insurance, Financial Institutions, and Professional Registration has a new report on the state's autism insurance mandate.  From the executive summary:
This is the fourth annual report to the Missouri General Assembly related to insurance coverage for autism treatment of autism spectrum disorders (ASDs), including applied behavioral analysis (ABA). The findings of the first annual report reflected the fact that 2011 was a transitional year during which much of the infrastructure necessary to deliver the mandated benefits was developed. As expected, data show that the benefits of the mandate were more fully realized over the subsequent period and continued to expand into 2014, while the costs as a percent of overall health care costs remained negligible.
1. Coverage. Coverage for ASD treatment, including ABA therapy, significantly expanded in the individual market in 2014. Prior to 2014, individual policies sold in Missouri were only required to offer autism benefits as an optional coverage that could be obtained with an additional premium. Due to federal law, all non-grandfathered plans were required to provide coverage for “essential health benefits,” (EHBs) as of January 1, 2014. Due to this requirement, coverage for autism treatment in the individual market was significantly expanded. During 2013, only a little more than one-third of individual policies covered mandated autism benefits. For 2014, more than 92 percent of individual polices provided the benefits as standard coverage.
2. Number served. The number of individuals receiving covered treatment in 2014 for autism and related conditions equaled 3,825, up from 3,070 in 2013 and 2,508 in 2012. This amounts to 1 of every 337 insureds, up from 1 in 431 insureds in 2013. While the number of individuals benefitting from covered autism treatment grew in the large and small group markets, the expansion was most dramatic in the individual market due to the expansion of coverage.
3. Licensure. The first licenses for applied behavior analysis were issued in Missouri in December 2010. As of mid-January 2014, 280 licenses had been issued, and an additional 53 persons obtained assistant behavior analyst licenses. Of these, 247 behavior analyst licenses were still active, as were 41 assistant behavior analyst licenses.[Click here for a table listing state laws on licensing and certification.]
4. Claim payments. Between 2011 and 2014, claim costs incurred for autism services increased from $4.3 million to nearly $10 million, of which $5 million was directed to ABA services. These amounts represent 0.21 percent and 0.11 percent of total claims incurred, consistent with initial projections produced by the DIFP.1 For each member month of autism coverage, total autism-related claims amounted to 50 cents, while the cost of ABA therapy amounted to 26 cents.

5. Average Monthly Cost of Treatment. For each individual diagnosed with an ASD who received treatment at some point during 2014, the average monthly cost of treatment across all market segments was $278. Of that average monthly cost, ABA therapies accounted for $142. The average, of course, includes individuals received minimal treatment as well as individuals whose treatments very likely cost significantly more.
6. Impact on Premiums. While costs associated with autism-related treatment have risen during the three years since the mandate was enacted, the fact that these costs represent just two-tenths of one percent of overall claim costs2 makes it very unlikely that they will have any appreciable impact on insurance premiums. However, because the DIFP has no authority over health insurance rates and does not receive rate filings, a more exact assessment of the impact of the mandate on rates cannot be determined.
7. Self-Funded Plans. This study focuses upon the licensed insurance market (i.e. those entities over which the DIFP has regulatory jurisdiction). Many employers provide health insurance by “self-insuring,” that is, by paying claims from their own funds. Such plans are governed under the federal Employee Retirement Income Security Act (ERISA), and states have little jurisdiction over private employers that choose to self-fund. The Missouri statute does extend the autism mandate to the Missouri Consolidated Health Care Plan (MCHCP), which covers most state employees, as well as all self-funded local governments and self-insured school districts.
1 The DIFP estimated that the mandate would produce additional treatment costs of between 0.2 percent and 0.8 percent. The analytical assumptions associated with the lower-end of the estimate range appear to be validated by the claims data presented in this report.
2 Prior to passage of HB 1311, the DIFP projected that the cost of the mandated benefits would equal between 0.2 and 0.8 percent of claim costs. Experience over the last four years indicates that actual costs are consistent with the lower bound of the projection.

Wednesday, February 4, 2015

Modest Increase for IDEA

Christina Samuels reports at Education Week:
Special education would see modest increases across the board in the budget proposal released Monday by the White House, but the money would still not approach the "full funding" that has been supported by a bipartisan group of lawmakers and by U.S. Rep. John Kline, a Republican from Minnesota and the chairman of the House education committee.

Funding for the Individuals with Disabilities Education Act in the U.S. Department of Education is split into several categories. The largest by far is IDEA Part B, which provides federal funding for students ages 3 to 21. The proposed increase for that program for fiscal 2016 is $175 million, taking the program from about $11.6 billion to approximately $11.7 billion.

Another portion of IDEA funding is Part C, which pays for early-intervention services for infants and toddlers up to age 2. I've written before about how Part C has not gotten the same level of funding attention as other early-childhood initiatives, but it does get a small bump in the proposal, from $439 million to $504 million.

Tuesday, February 3, 2015

Pols and Vaccines

Gov. Chris Christie’s trade mission to London was suddenly overshadowed on Monday after he was quoted as saying that parents “need to have some measure of choice” about vaccinating their children against measles. The New Jersey governor, who is trying to establish his credibility among conservatives as he weighs a run for the Republican nomination in 2016, later tried to temper his response. His office released a statement clarifying that “with a disease like measles there is no question kids should be vaccinated.”
 Senator Rand Paul of Kentucky, a physician, was less equivocal, telling the conservative radio host Laura Ingraham on Monday that parents should absolutely have a say in whether to vaccinate their children for measles.
“While I think it’s a good idea to take the vaccine, I think that’s a personal decision for individuals,” he said, recalling his irritation at doctors who tried to press him to vaccinate his own children. He eventually did, he said, but spaced out the vaccinations over a period of time.
Asked about immunizations again later on Monday, Mr. Paul was even more insistent, saying it was a question of “freedom.” He grew irritated with a CNBC host who pressed him and snapped: “The state doesn’t own your children. Parents own the children.”
Nia-Malika Henderson reports at The Washington Post:
New Jersey Gov. Chris Christie (R) and Sen. Rand Paul (R-Ky.) both said Monday that they favor "choice" when it comes to whether parents get their kids vaccinated. This was seen by the Democratic National Committee as "kowtowing to the fringe rhetoric of the anti-vaccination movement."
"Chris Christie isn't a scientist. He isn't a doctor. And he sure as heck isn't a leader," DNC spokesman Mo Elleithee said. "If his campaign is going to be about kissing up to the radical, conspiracy theory base that’s wagging the dog of today’s Republican Party, that’s up to him and his cracker-jack team."
Here are some Democratic figures who might want to have a word with the DNC:

Andrew Kaczynski reports at Buzzfeed:
For more than two decades, Kentucky Sen. Rand Paul was a member of a group, the Association of American Physicians and Surgeons, that advocated a link between vaccinations and autism, among other conspiracy theories.
The AAPS, as Kentucky’s Courier-Journal noted in a 2010 article on Paul’s association with it, opposes mandatory vaccinations and promoted discredited studies, which linked the vaccine-component thimerosal to autism in children.
“Mandatory vaccines violate the medical ethic of informed consent. A case could also be made that mandates for vaccines by school districts and legislatures is the de facto practice of medicine without a license,” the group said in a fact-check.
Paul’s adviser, Doug Stafford, told BuzzFeed News he didn’t know if Paul was still a member of the group but that he joined because it was a group of pro-life doctors. He said Paul does not endorse all the group’s views.
Jane Orient, who handles media for AAPS, said she did not believe Paul had renewed his membership.