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Tuesday, August 21, 2018

A Five Billion Dollar Business

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

From Market Research Future:

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

Monday, August 20, 2018

Measles Case Soar in Europe

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

Over 41 000 children and adults in the WHO European Region have been infected with measles in the first 6 months of 2018. The total number for this period far exceeds the 12-month totals reported for every other year this decade. So far, the highest annual total for measles cases between 2010 and 2017 was 23 927 for 2017, and the lowest was 5273 for 2016. Monthly country reports also indicate that at least 37 people have died due to measles so far this year.
“Following the decade’s lowest number of cases in 2016, we are seeing a dramatic increase in infections and extended outbreaks,” says Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “We call on all countries to immediately implement broad, context-appropriate measures to stop further spread of this disease. Good health for all starts with immunization, and as long as this disease is not eliminated we are failing to live up to our Sustainable Development Goal commitments.”
Seven countries in the Region have seen over 1000 infections in children and adults this year (France, Georgia, Greece, Italy, the Russian Federation, Serbia and Ukraine). Ukraine has been the hardest hit, with over 23 000 people affected; this accounts for over half of the regional total. Measles-related deaths have been reported in all of these countries, with Serbia reporting the highest number of 14.

Rory Smith at CNN:
And where anti-vaccine sentiment has taken root -- such as in Italy -- measles is generally the first disease to manifest given its contagiousness, according to Heidi Larson, of the London School of Hygiene and Tropical Medicine.
Italy's anti-establishment government recently passed a new amendment that suspends a law requiring parents to provide proof that their children received a series of 10 vaccines -- including the MMR (measles, mumps, and rubella) vaccine -- when enrolling them in nurseries and preschools.
"Now, children who are not vaccinated will endanger other children at school who are too small for vaccines or cannot be vaccinated because they suffer from immunosuppressive diseases," said Dr. Roberto Burioni, a professor of microbiology and virology at San Raffaele University in Milan.
France and Romania, along with Italy, are among European countries with the highest anti-vaccine sentiment, where around 20% of the population believes vaccines are unsafe.
The infamous Wakefield study pubished in 1998 stated that the MMR vaccine caused autism in children who received the vaccine. The results of the study turned out to be untrue and Andrew Wakefield, one of the authors of the study, had his medical license revoked.
Despite the medical fraud, the myth persists, and many vaccine skeptics still believe their children will develop autism if they are immunized.

Sunday, August 19, 2018

Inequities in Age of Treatment Receipt

In The Politics of Autism, I write about the experiences of different economicethnic and racial groups


From the article:
This study, which is the first to examine inequity in age of treatment receipt among a nationally representative sample of children with ASD, demonstrates inequitable access to treatment. Specifically, we detected relationships between age of treatment receipt and two predisposing social characteristics, or race-ethnicity and perceived neighborhood cohesion. It is concerning that compared to White children, the odds of entering treatment at 3 years and ⩾4 years were much greater for non-Hispanic Black children. This finding aligns with consistent evidence that Black children with ASD are diagnosed later and are initially misdiagnosed (Daniels and Mandell, 2013).
...
After controlling for child race-ethnicity and covariates, children whose parents perceived their neighborhood to be cohesive began treatment earlier than children whose parents did not. Byrnes and Miller (2012) reported that the positive relationship between perceived neighborhood cohesion and effective parenting behaviors is mediated through social support. Thus, parents who perceive neighborhood cohesion might perceive greater social support from and more frequently communicate with neighbors and more often interact with other parents and young children. In turn, these parents might be more likely to compare and discuss their child’s development, including available community resources that promote development. To the contrary, parents who do not perceive  neighborhood cohesion might not receive feedback about their child’s development until preschool or later.

Saturday, August 18, 2018

One in Four Adults Has a Disability

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

From CDC:
One in 4 U.S. adults – 61 million Americans – have a disability that impacts major life activities, according to a report in CDC’s Morbidity and Mortality Weekly Report.
The most common disability type, mobility, affects 1 in 7 adults. With age, disability becomes more common, affecting about 2 in 5 adults age 65 and older.
“At some point in their lives, most people will either have a disability or know someone who has a one,” said Coleen Boyle, Ph.D., director of CDC’s National Center on Birth Defects and Developmental Disabilities. “Learning more about people with disabilities in the United States can help us better understand and meet their health needs.”
Six types of disability measured
Using data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS), this is the first CDC report of the percentage of adults across six disability types:

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

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

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

“People with disabilities will benefit from care coordination and better access to health care and the health services they need, so that they adopt healthy behaviors and have better health,” said Georgina Peacock, M.D., M.P.H., Director of CDC’s Division of Human Development and Disability. “Research showing how many people have a disability and differences in their access to health care can guide efforts by health care providers and public health practitioners to improve access to care for people with disabilities.”
CDC is committed to protecting the health and well-being of people with disabilities throughout their lives. Through its State Disability and Health Programs and national collaborations, CDC will continue to work to lower health differences faced by people with disabilities. To advance this goal, CDC provides information and resources for public health practitioners, doctors, and those who care for people with disabilities.
For more information about CDC’s work to support inclusive settings for people with disabilities, go to http://www.cdc.gov/disabilities.

Friday, August 17, 2018

Measles Redux

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

From CDC:
From January 1 to July 14, 2018, 107 people from 21 states (Arkansas, California, Connecticut, Florida, Illinois, Indiana, Kansas, Louisiana, Maryland, Michigan, Missouri, Nevada, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, and Washington) and the District of Colombia were reported to have measles.
In 2017, 118 people from 15 states and the District of Columbia were reported to have measles. In 2016, 86 people from 19 states were reported to have measles. In 2015, 188 people from 24 states and the District of Columbia were reported to have measles. In 2014, the United States experienced a record number of measles cases, with 667 cases from 27 states reported to CDC’s National Center for Immunization and Respiratory Diseases (NCIRD); this is the greatest number of cases since measles elimination was documented in the U.S. in 2000.
  • The majority of people who got measles were unvaccinated.
  • Measles is still common in many parts of the world including some countries in Europe, Asia, the Pacific, and Africa.
  • Travelers with measles continue to bring the disease into the U.S.
  • Measles can spread when it reaches a community in the U.S. where groups of people are unvaccinated.

Thursday, August 16, 2018

DDT and Autism

In The Politics of Autism, I discuss various ideas about what causes the conditionHere is just a partial list of correlates, risk factors, and possible causes that have been the subject of serious studies:


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

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

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

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

Wednesday, August 15, 2018

Texas Must Spend More for Special Ed


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

In eliminating that cap, state officials estimate that it will cost the state billions of dollars to provide special education services to an additional 189,000 students who need them.
The state legislature eliminated caps on special education services last year, and the federal government is requiring school districts to evaluate special needs students and offer compensatory services. As more students are identified, the state will have to pay for those resources. TEA officials told a group of lawmakers Thursday that it estimates the state will need an additional $682 million for special education services in fiscal year 2019, an additional $1 billion in 2020 and $1.55 billion in 2021. That's more than $3.2 billion in the next three years.

Tuesday, August 14, 2018

HEADS UP

The Politics of Autism discusses health care, and explains that autism services can be complicated, creating difficulties for autistic people and their families. 

Last week, to commemorate the 28th anniversary of the passage of the Americans with Disabilities Act (ADA), Congressman Seth Moulton (D-MA), and Congressman Gregg Harper (R-MS), introduced the Healthcare Extension and Accessibility for Developmentally Disabled and Underserved Population (HEADs Up) Act of 2018.[HR 6611] The HEADs Up Act would designate people with Intellectual and Developmental Disabilities (I/DD) as a Medically Underserved Population (MUP) under the Health Services and Resources Administration (HRSA), opening up access to much needed primary care and specialist services, incentivizing new research, and authorizing more favorable reimbursement rates for providers who treat this population.

“The best way to celebrate the 28th anniversary of the signing of the Americans with Disabilities Act and the 50th Anniversary of the Special Olympics is to take the next step towards ensuring that those living with intellectual and developmental disabilities can live full and happy lives,” said Moulton. “Every person with intellectual and developmental disabilities should be fully integrated into our communities. But right now, we’re failing to give them basic healthcare. This needs to stop. We have the opportunity to create a turning point in the way we care for some of the most medically underserved people in our country. Access to healthcare is a human right, and we have an obligation to make sure that those most in need are getting the care they deserve.”
The “Medically Underserved” designation was created with the passage of the Health Centers Consolidation Act of 1996. Despite years of advocacy and ample evidence that people with I/DD qualify as a MUP, they still have not been designated as one. The designation as a special medically underserved population would open up over 25 government programs within the HRSA and other federal agencies for participation by the I/DD population. These programs include:
  • Federal funding for health centers and public health infrastructure such as Federally Qualified Health Centers (FQHC),
  • Eligibility to apply for federal funding to develop and operate Community Health Centers,
  • Access to loan repayment and training programs in HRSA’s Workforce Development and Training Programs including the national Health Service Corps Scholarships,
  • Incentives for physicians to treat this population in the form of higher CMS reimbursement rates for physician services delivered in Health Professional Shortage Areas, a designation closely related to MUP,
  • Preference given to research at federal agencies, including the NIH, that studies medically underserved population.
“Research shows that individuals with Intellectual and Developmental Disabilities (IDD) experience health disparities, as healthcare providers often do not receive the necessary training to provide proper care to the IDD community,” said Harper. “Increasing opportunities and improving the quality of life for IDD individuals has been a priority for me during my service in Congress. I am pleased to work with Representative Moulton on the HEADs Up Act of 2018 to continue this important conversation.”

The following groups have endorsed the HEADs Up Act:
  • American Network of Community Options and Resources (ANCOR)
  • National Council on Disability
  • ARC
  • Autism Society
  • The National Association of State Directors of Developmental Disabilities Services (NASDDDS)
  • Special Olympics
  • National Down Syndrome Congress
  • MENTOR
“Special Olympics strongly supports legislation, like the HEADs UP Act, that advances the rights, participation and integration of people with intellectual disabilities in communities across America,” said Dr. Timothy P. Shriver Ph.D., Chairman, Special Olympics International. “We thank Congressman Moulton and Congressman Gregg Harper for their championship of this bill. Special Olympics looks forward to continuing its work with Congress to end the stigma, stereotypes, isolation and discrimination that Americans with intellectual disabilities face around access to sport, health and education. The HEADs UP Act will go a long way towards ending well documented health disparities for people with Intellectual and Developmental Disabilities by appropriately designating those fellow Americans as a Medically Underserved Population as a result of so many lacking in the health care they desperately need and deserve.”
“Increasing access to dental health services for people with intellectual and developmental disabilities is an incredibly important issue because data overwhelmingly shows the connection between dental health and overall health outcomes, but the issue has flown under the radar for far too long,” said Barbara Merrill, CEO of ANCOR. “We are so grateful that Representative Moulton has asserted himself as a champion for this issue because we know that designating people with I/DD as a medically underserved population will help us make great strides in connecting people with the dental care they need and deserve.”

Monday, August 13, 2018

No Link Between Tdap and Autism

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

A study of women who received a Tdap vaccination during pregnancy found no increase in risk that their children would later be diagnosed with autism spectrum disorder. The study, “Prenatal Tetanus,Diphtheria, Acellular Pertussis Vaccination and Autism Spectrum Disorder,” will be published in the September 2018 issue of Pediatrics (published online Aug. 13). Researchers reviewed the records of 81,993 pairs of diverse pregnant women and their children who were born between Jan. 1, 2011, and Dec. 31, 2014, at Kaiser Permanente Southern California hospitals. Following up with the mother-child pairs, they identified children who had been diagnosed with autism spectrum disorder after age 1 through June 30, 2017. The incidence rate of autism spectrum disorder was 3.78 per 1,000 people in the Tdap-vaccinated group. The rate of autism spectrum disorder was 4.05 per 1,000 in the unvaccinated group. The Tdap vaccine has been shown in prior research as effective in protecting young infants from pertussis, which has risen in incidence in the past decade. Evidence showed that antibodies are passed along to newborns and that the vaccine was 91.4 percent effective in providing some immunity until newborns reached 2 months of age.

Sunday, August 12, 2018

ABLE Age Adjustment Act

The Politics of Autism includes a discussion of the ABLE Act.

From the Autism Society:
The Autism Society and other national disability groups used the ADA anniversary to spur action on the ABLE Age Adjustment Act. In 2014 Congress passed the ABLE Act, which authorized the creation of savings accounts for people to save money for disability-related expenses without jeopardizing their eligibility for public benefits like Supplemental Security Income (SSI) and Medicaid. These accounts are important because people with disabilities can lose their eligibility for public benefits if they accumulated more than $2,000 in assets if they do not have access to an ABLE account. While the ABLE Act performs a valuable service, only those that acquire a disability before age 26 are eligible. The ABLE Age Adjustment Act increases the age cut-off to 46 years of age which would allow an additional 6 million people with disabilities. Autism Society affiliates are encouraged to reach out to their Members of Congress to urge them to co-sponsor this bill. A sample letter is provided in the ASA Action Center.

Saturday, August 11, 2018

The ADA Is 28

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

The Autism Society recently observed the 28th anniversary of the Americans with Disabilities Act (ADA)
The Autism Society published a statement celebrating the civil rights law, acknowledging the history and evolution of disability rights, and pledging to continue its mission to support people with autism and other disabilities and their families. This mission includes protecting the ADA and other civil rights laws that promote the vision of full inclusion of people with autism and other disabilities. The US Department of Health and Human Services (HHS) Administration for Community Living (ACL) also published a statement using the ADA anniversary to reaffirm its commitment to the “fundamental principle that older adults and people of all ages with disabilities should be able to live where they choose, with the people they choose and with the ability to participate fully in their communities
Two years ago, David A. Graham wrote at The Atlantic:
Disability politics used to be bipartisan. The Americans with Disabilities Act was primarily authored by Senator Tom Harkin, an Iowa Democrat. It passed the Senate and House overwhelmingly—91-6 and 377–28, respectively, and was signed into law by President George H.W. Bush in 1990. When he signed the law, Bush said:
Now I sign legislation which takes a sledgehammer to another wall, one which has for too many generations separated Americans with disabilities from the freedom they could glimpse, but not grasp. Once again, we rejoice as this barrier falls for claiming together we will not accept, we will not excuse, we will not tolerate discrimination in America…. To those Members of the House of Representatives with us here today, Democrats and Republicans as well, I salute you. And on your behalf, as well as the behalf of this entire country, I now lift my pen to sign this Americans with Disabilities Act and say: Let the shameful wall of exclusion finally come tumbling down.
Eighteen years later, Bush’s son George W. Bush signed some expansions of the ADA into law.

Since then, however, things have sputtered. In 2012, the Senate failed to ratify a United Nations treaty called the Convention on the Rights of Persons With Disabilities. Democrats supported the treaty, but Republicans were split. On the pro side were George H.W. Bush and Bob Dole, the former Senate GOP leader and presidential candidate who was injured during World War II. On the con side were a bloc who warned on extremely dubious grounds that the treaty would allow the UN to meddle in U.S. courts. In the end, the treaty failed, despite Dole himself appearing on the Senate floor to lobby. It needed two-thirds of votes to pass, but was only able to garner 61

Friday, August 10, 2018

Project Lifesaver

The Politics of Autism discusses the problem of wandering, which has been the topic of legislation.

An autistic teen from Waterford, New York, went missing this week and apparently drowned in the Mohawk River.

Bethany Bump at The Times-Union in Albany:
The search for both Blaauboer and Williams could have been over in hours, if not minutes, if the two had been enrolled in the Project Lifesaver program, officials have suggested.
Developed in 1999 as a way to bring peace of mind to caregivers of individuals with cognitive disorders such as autism, Alzheimer's and other dementias, those enrolled in the program wear a small transmitter on the wrist or ankle that emits an individualized frequency signal. If they go missing, the caregiver notifies local law enforcement, who can use the technology to pinpoint their location.
There are similar technologies with other names, but Project Lifesaver was one of the first and is used by the majority of county sheriff's offices around the region.

"Thinking about my 16-year-old son Michael who lives with autism, I know how children with autism can tend to wander," said Assemblyman Angelo Santabarbara, who helped bring the program to his home county of Schenectady in 2015.
"It's critical that we invest in this life-saving technology to protect our most vulnerable citizens," he said.
Santabarbara introduced a bill in April to expand the technology statewide to those who need it. In addition to the technology, law enforcement agencies need training in how to use the program, he said.

Thursday, August 9, 2018

Career and Technical Education

In The Politics of Autism, I discuss the employment of adults with autism and other disabilitiesMany posts have discussed programs to provide them with training and experience.

From Autism Speaks:
The Carl D. Perkins Career and Technical Education Act was reauthorized on July 31, 2018. This law increases access to employment opportunities for people with autism and other disabilities.

Perkins-funded CTE programs provide the skills training and experience that are critical for guiding youth through the transition out of secondary school into employment or continued education.

Approximately 500,000 youth with autism will enter adulthood over the next 10 years. Over one-third of young adults with autism never get a job or continue education after high school.

Perkins helps students with disabilities secure employment after graduation by integrating youth into the labor market early. It supports cooperative education which combines academic study and career and technical education (CTE) with work experience in a related field.

The reauthorization of Perkins CTE supports a well prepared, community-led, inclusive workforce by encouraging
  • Proven CTE programs, practices, and strategies
  • A broad CTE framework more closely aligned with the Workforce Innovation Opportunity Act
  • Community involvement by connecting local job markets to local schools
  • Workplace-based training
  • Relationships between individuals on the spectrum and potential employers
  • Improved accountability and performance indicators
The Strengthening Career and Technical Education for the 21st Century Act was originally passed by the U.S. House of Representatives in June 2017. The U.S. Senate amended the bill and passed the legislation on July 23, 2018. The House adopted the Senate's language and passed the bill on July 25. The president signed it into law on July 31.

Autism Speaks served as a primary stakeholder on Perkins CTE reauthorization. We worked across the aisle with party leadership of the Senate HELP and House Education and Workforce committees. We also provided assistance to our legislative champions, Representatives Thompson and Krishnamoorthi and Senators Enzi and Casey. We are prepared to assist with the implementation of the new law going forward.

Wednesday, August 8, 2018

Antivax Victory in Italy

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





An amendment from Italy's anti-establishment government that removes mandatory vaccination for schoolchildren is sending shock waves through the country's scientific and medical community.
It suspends for a year a law that requires parents to provide proof of 10 routine vaccinations when enrolling their children in nurseries or preschools. The amendment was approved by Italy's upper house of parliament on Friday by 148 to 110 votes and still has to pass the lower house.

The law had originally been introduced by the Democratic Party in July 2017 amid an ongoing outbreak of measles that saw 5,004 cases reported in 2017 -- the second-highest figure in Europe after Romania -- according to the European Centre for Disease Prevention and Control (ECDC). Italy accounted for 34% of all measles cases reported by countries in the European Economic Area, the center said.
The anti-vax vote is significant in Italy, with widespread distrust of vaccinations dating back to a later debunked and retracted 1998 study that claimed to show a link between the measles, mumps and rubella (MMR) vaccine and autism. As late as 2012, a court in Italy ruled that a child’s autism had been caused by the MMR vaccine, fueling the anti-vaccination movement. That ruling was overturned in 2015, but its effect seems to linger: A 2017 study of Italian internet habits between 2010 and 2015 found a connection between search and social media activity around the MMR vaccine and lower vaccination rates.
After the Five Star Movement and the League formed a coalition government in May, Interior Minister Matteo Salvini said that the 10 mandatory vaccines were “useless and in many cases dangerous, if not harmful.”
Health Minister Giulia Grillo says requiring 10 vaccines threatens “school inclusion” and that the government want to “simplify rules for parents.”

Tuesday, August 7, 2018

Texas Antivax Hotpsots

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

"It's so frustrating because I can see this train coming two miles down the tracks," said Dr. Peter Hotez, director of the Texas Children's Hospital Center for Vaccine Development and dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. "And I can't do much to stop it other than just try to talk about vaccines, why they're safe, why the evidence shows there's clearly no link between vaccines and autism."

...

Hotez’s research has showed big clusters of exemptions in the western part of the country and in pockets where parents have slightly more wealth and education. His study showed Texas had the most “hot spots” of kindergartners whose parents, for nonmedical reasons, kept them from getting vaccinations against diseases such as measles, mumps, chicken pox and whooping cough.
Texas is among 18 states that let families opt out of vaccines for personal or moral beliefs, according to the National Conference of State Legislatures. And Plano, Fort Worth, Austin and Houston all ranked among the 15 U.S. metro areas with the most such conscientious exemptions for kindergartners. Each had more than 400 kindergartners exempted from vaccines.
Conscientious objections have risen steadily in the state over the past five years and now top 1 percent for the first time in recent years. Texas reported that 56,738 students — from kindergarten to 12th grade — opted out last school year. That’s an increase of almost 4,000 students from the previous year, according to the Texas Department of Health and Human Services.

Hotez, who is the father of an autistic daughter, is most concerned about how exemption hot spots can put more people at risk for outbreaks of childhood infections. He said people tend to look at national and statewide rates and say, "They're not that alarming."
But those numbers, he said, “mask pockets in these schools.”

Monday, August 6, 2018

IVF

In The Politics of Autism, I write:
If the science were not confusing enough, its coverage in the mass media has added another layer of murk. News reports hype tentative findings and weak correlations as “breakthroughs” in the quest for autism answers. When the research yields mixed results, the media headlines can be comically inconsistent. Consider how various publications covered a 2013 study on the impact of in vitro fertilization:
  • RARE IN VITRO TECHNIQUE RAISES AUTISM RISK, STUDY SAYS
  • IVF PROCEDURES DO NOT BOOST AUTISM RISK
  • SOME FORMS OF IVF LINKED TO AUTISM, MENTAL DISABILITY
  • IVF, AUTISM NOT LINKED, BUT STUDY FINDS RISK OF INTELLECTUAL DISABILITY[i]
[i] John J. Pitney, Jr., “IVF, Autism, and Headlines,” Autism Policy and Politics, July 2, 2013. Online: http://www.autismpolicyblog.com/2013/07/ivf-autism-and-headlines.html; “Autism and IVF: More Contradictory Headlines,” Autism Policy and Politics, July 3, 2013. Online: http://www.autismpolicyblog.com/2013/07/autism-and-ivf-more-contradictory.html
Now a headline at Xinhua:  SOME FERTILITY TREATMENTS CAN CAUSE AUTISM: ISRAELI RESEARCH
 Fertility treatments may increase the risk of autism in children, according to a research published by the University of Haifa in northern Israel Sunday.
In recent years, efforts have been made to identify the environmental factors that influence the development of autism. One of the directions that has not been thoroughly tested is the effect of fertility treatments.
Today there is a scientific and medical controversy. Some studies have found that there is no connection between fertility treatments and autism, especially IVF (In vitro fertilisation) treatments. Other studies have linked to individual hormones and autism.
The new study, which also included researchers from Mount Sinai Hospital in New York and the Karolinska Institute in Sweden, included 108,548 boys, as boys have a higher risk of developing autism than girls.
In the case of progesterone hormone therapy, it was found that the odds of having a child on the autistic spectrum were 1.5 times higher than those who did not undergo fertility treatments.
Among other things, beware the word cause the headline.  As every social scientist knows, correlation is not the same as causation.

Sunday, August 5, 2018

Autism and Employment: The Research

In The Politics of Autism, I discuss the employment of adults with autism and other disabilitiesMany posts have discussed programs to provide them with training and experience.

Melissa Scott and colleagues have an article at Autism titled "Factors Impacting Employment for People with Autism Spectrum Disorder: A Scoping Review."

The lay abstract:
Adults with Autism Spectrum Disorder (ASD) possess unique strengths and abilities. Despite increasing recognition of the potential contribution that individuals with ASD can make in the workplace, they continue to experience challenges in finding and maintaining a job. This review examined the factors relating to the employment of individuals with ASD. Database searches were conducted. Studies describing adults with ASD employed in competitive, supported or sheltered employment were included. A technique called content analysis was used to identify the strengths and abilities in the workplace of employees with ASD. Lastly, meaningful concepts relating to employment interventions were linked to the International Classification of Functioning, Disability and Health (ICF) Cores Sets for ASD (these are a way of categorising and describing how individuals with ASD function across the lifespan). The search identified 134 studies for inclusion. Of these studies, only 14 explored the strengths and abilities of individuals with ASD in the workplace including attention to detail, high quality of work and a strong sense of morality. Thirty-six studies evaluated employment interventions for adults with ASD, with a focus on modifying ASD characteristics for improved job performance, with little consideration of the impact of environmental factors on work participation. The ICF Core Sets for ASD were found to be a useful tool in holistically examining the employment literature. This review highlighted the key role that environmental factors play as barriers and facilitators in the employment of people with ASD and the critical need for interventions to target both personal and environmental factors if employment outcomes are to be improved.
From the article:
To date, ASD research has largely focussed on diagnosis and early intervention services for children, and as confirmed by the findings of the current review, a paucity of literature has focussed on examining the relative effectiveness of interventions in adulthood (Hedley et al., 2016; Howlin et al., 2015; Schall et al., 2015). Of the 134 employment studies identified for inclusion in this review, only 36 were intervention based. While these interventions studies had the stated collective purpose of improving employment outcomes, they were primarily impairment-focussed, targeting their interventions at intrinsic individual ASD characteristics, with little consideration of contextual influences. Interventions targeted ASD traits commonly associated with difficulties in finding and obtaining a job, such as executive functioning skills in relation to problem-solving, organisation, task management and behaviour regulation and social-communication skills required in interviews and workplace interactions (American Psychiatric Association, 2013; Hendricks, 2010; Müller et al., 2003). While many of these interventions were effective in increasing measured vocational and executive functioning skills, many participants continued to remain unemployed. The continuing high rates of unemployment among participants following these interventions suggest that impairment-focussed interventions alone are not sufficient in achieving and maintaining successful work-related outcomes for individuals with ASD (Ellenkamp et al., 2016). 
  • American Psychiatric Association (2013) Diagnostic andStatistical Manual of Mental Disorders. 5th ed. Text revision.Arlington, VA: American Psychiatric Publishing.
  • Ellenkamp J, Brouwers E, Embregts P, et al. (2016) Work environment-relatedf actors in obtaining and maintaining work in a competitive employment setting for employees with intellectual disabilities: a systematic review. Journal ofOccupational Rehabilitation 26: 56–69
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Saturday, August 4, 2018

Disparities in Disability Employment

In The Politics of Autism, I discuss the employment of adults with autism and other disabilitiesMany posts have discussed programs to provide them with training and experience.

Martha Ross and Nicole Bateman at Brookings:
Employment rates among prime-aged adults with disabilities in the 100 largest metropolitan areas range from 28 percent to 60 percent (Map 1). Workers and would-be workers with disabilities fare better in places where higher shares of the overall working-age population are employed. Such places include Madison, Wis.; Minneapolis-St. Paul, Minn.; Washington, D.C.; Denver, Colo.; Austin, Texas; Wichita, Kan.; Omaha, Neb.; and Boise, Idaho.
Nonetheless, even in places with high employment rates among people with disabilities, the gap relative to the population as a whole is huge, anywhere from 20 to 35 percentage points. For example, in Minneapolis-St. Paul, the employment rate among adults with disabilities is 51 percent, compared to 87 percent among all adults. In fact, the highest employment rate among people with disabilities (60 percent in Madison, Wis.) is still below the rate for all working-age adults in Bakersfield, Calif. (70 percent), the region with the lowest employment rate among the 100 largest metro areas.
Employment rates also vary by race, ethnicity, and education level.
Employment gaps of the magnitude described above stem from multiple sources. Federal disability policy emphasizes income support and disincentives employment, with only an estimated 1 percent of federal and state expenditures on working-age people with disabilities going to education, training, and employment. Turning to education, improving opportunities and removing barriers for students with disabilities is an ongoing process, as evidenced by the lower levels of educational attainment among people with disabilities. Employers may be unaware of the capacity of people with disabilities, unfamiliar with how to recruit and hire them, and unfamiliar as well with workplace accommodations. Moreover, several reports document that people with disabilities face attitudinal barriers and stigma in the labor market, a perception that is reinforced by a recent field study finding that employers were less likely to respond to resumes and cover letters from job candidates who disclosed disabilities, even when the candidates were equally qualified as those without disabilities.

Friday, August 3, 2018

Medical Cannibis in Minnesota

In The Politics of Autism, I write:
The conventional wisdom is that any kind of treatment is likely to be less effective as the child gets older, so parents of autistic children usually believe that they are working against the clock. They will not be satisfied with the ambiguities surrounding ABA, nor will they want to wait for some future research finding that might slightly increase its effectiveness. They want results now. Because there are no scientifically-validated drugs for the core symptoms of autism, they look outside the boundaries of mainstream medicine and FDA approval. Studies have found that anywhere from 28 to 54 percent of autistic children receive “complementary and alternative medicine” (CAM), and these numbers probably understate CAM usage
These approaches sometimes include marijuana.

From JD Supra:
On August 1, 2018, some Minnesotans diagnosed with obstructive sleep apnea or autism will be able to use medical cannabis to alleviate symptoms associated with those conditions for the first time. Individuals diagnosed with either condition were eligible to begin the state’s registration and enrollment process on July 1, 2018, for access to medical cannabis beginning one month later. These most recent additions to Minnesota’s medical cannabis “qualifying conditions” list exemplify a significant shift in potential eligibility for medical cannabis. In the early years of medical cannabis, states often restricted eligibility to a short list of very severe conditions. However, several states have since expanded their qualifying conditions lists – meaning that individuals diagnosed with a wide variety of conditions may now be using medical cannabis. This raises a number of issues for employers; schools/childcare providers; and healthcare providers who are increasingly likely to have employees, students, or patients who are using or pursuing medical cannabis.

Official details here.