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Friday, November 30, 2018

Case Against Subminimum Wages

In The Politics of Autism, I discuss the employment of adults with autism and other disabilities.

At The Hill, Mark Riccobono, President of the National Federation of the Blind, arguest against subminimum wages:
The Fair Labor Standards Act, passed in 1938, was a landmark law enacted with the specific intention of protecting the rights of American workers. It established such modern norms as a 40-hour workweek, overtime pay, restrictions against child labor, and the federal minimum wage. However, it also introduced an exception to that minimum wage with the inclusion of Section 14(c), which allows employers to obtain a special wage certificate granting the permission to pay people with disabilities at a rate “lower than the minimum wage.” There it is in black and white, discrimination codified into United States law.
To put it bluntly, Americans with disabilities do not want your pity. We want your respect. We want you to respect us enough to extend the opportunity to work in a meaningful job, to work side-by-side with you toward a common goal, and most importantly to earn a living wage so that we can be independent.

The American Dream is generally understood as the opportunity for anyone, regardless of background, to achieve success and prosperity through hard work and determination. Section 14(c) creates a second class of citizens, based solely on disability, that are unable to experience the benefits of that dream. Americans with disabilities are determined, we are willing, and we are most definitely able to work hard, but regardless of how hard we work, success and prosperity will always be well out of reach as long as Section 14(c) is on the books. Our nation’s commitment to end discrimination against people with disabilities must include ending the payment of subminimum wages, otherwise it is nothing more than a hollow platitude.

Thursday, November 29, 2018

Diagnosis Disparity

Dr. John N. Constantino, Anna M. Abbacchi, and Robert Fitzgerald at The St. Louis American:
Historically, African-American children have been identified with autism spectrum disorder at a significantly lower rate than Caucasian children, but this gap has narrowed: across all network monitoring sites, autism remains about 7 percent more likely to be identified in Caucasian children than African-American children, and there is no evidence that this disorder is more common in any one race than another.

A serious residual disparity revealed by the CDC’s most recent network report is that African-American children who were identified with an autism spectrum disorder were twice as likely as Caucasian children to be co-diagnosed with an intellectual disability (44 percent compared to 22 percent). In other words, when an African-American child has this common condition, he/she is much more likely to suffer also from intellectual disability.
Researchers at the Washington University School of Medicine have recently been awarded funding by the National Institute of Mental Health (NIMH) to address this disparity, which may be caused by delays in the timing of diagnosis and access to high-quality intervention.

Wednesday, November 28, 2018

More on the National Survey of Children's Health

In The Politics of Autism, I discuss the likelihood that the increase in autism diagnoses and educational determinations at least partially the result of increased awareness and changes in diagnostic criteria

An estimated 1 in 40 American parents report having a child with autism, according to a newly published analysis of the 2016 National Survey of Children’s Health.
The national survey, led by the U.S. Health Resources and Services Administration, involved phone interviews with more than 50,000 parents of children (birth to 17 years old) across the country. Its autism-specific results appear online today in the medical journal Pediatrics.
The survey’s estimate of autism prevalence is significantly higher than the current official estimate of 1 in 59, published by the Centers for Disease Control and Prevention (CDC) earlier this year.
The difference in prevalence rates is likely due to differences in methods, says Autism Speaks Chief Science Officer Thomas Frazier. “One in 40 is closer to what we see with direct prevalence studies where researchers go into a community to directly screen for autism.”
Autism Speaks has funded two such direct-screening studies – one in South Korea and another in South Carolina. The South Korea study found an autism rate of 1 in 38. The results of the South Carolina study are pending.

By contrast, the CDC’s official estimate is based on a review of medical and school records for 8-year-olds at sampling sites across the country. It can miss children with autism who aren’t receiving services. It also reflects differences in record keeping among states.
Persistent obstacles to care
The National Survey of Children’s Health included a broad range of questions regarding access to healthcare and special-education services for children.

It found that, compared to parents of children with other developmental or behavior conditions, the parents of children with autism were:
* 44 percent more likely to report problems obtaining treatment
* 23 percent less likely to report their child having a medical home
* 24 percent less likely to receive help with care coordination.
“Though we’ve seen progress in recent years, this confirms what we know from our parents – that many children face unacceptable delays in getting a diagnostic evaluation, even after parents, teachers or other caregivers have recognized the signs of autism,” Dr. Frazier says.
“Unfortunately access to treatment can be even worse in many communities,” he adds. “Many children, particularly in low-resource areas, are not getting the kind of early intervention services that we know can improve outcomes.”

Tuesday, November 27, 2018

Editorial Boards v. Anti-Vaxxers

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

Outbreaks of preventable diseases have given editorial boards an opening to debunk the autism-vaccine notion.

St. Louis Post-Dispatch:
People opt out of vaccinations for various reasons. Some, like President Donald Trump, fear vaccines cause autism (they don't, as now-Health and Human Services Secretary Ben Carson tried to explain to Trump during a 2016 campaign debate). Others worry about various ingredients found in some vaccines, like aluminum (none of these are dangerous). Another group protests on religious grounds.
It's tempting to say government shouldn't force people to get vaccines, and that people deserve the freedom to make their own choices about vaccines. But those who forgo vaccinations aren't just making choices for themselves; they're making choices for the vulnerable populations that rely on herd immunity.
Burlington Times-News:
 As it is with other immunizations, rumors and incorrect information about this and many other vaccines have spread across the country, especially on social media. One of the leading misinformed theories is that the vaccines can cause autism. The initial research was found to be fraudulent and subsequent testing has thoroughly debunked the claim. Yet it has taken on a life of its own, gaining adherents and causing outbreaks of illnesses that had nearly been eliminated.
Asheville Citizen-Times:
Even more disturbing are those who base their opposition to immunization on the quack science that has been making the rounds on the Internet. The most noted example is the claim of a link between the measles-mumps-rubella vaccine and autism.
That claim was made in a 1998 British paper so poorly done that it later was retracted by its publisher. At least 12 follow-up studies have shown no link whatsoever. Nevertheless, a lot of people continue to oppose the MMR vaccine based on the original study.
That is sad, but it shouldn’t be surprising given the growth of anti-science attitudes in our society. The idea of subjecting ideas to rigorous testing is rejected to favor of saying something and assuming it to be true.

Monday, November 26, 2018

One in Forty

In The Politics of Autism, I discuss the likelihood that the increase in autism diagnoses and educational determinations at least partially the result of increased awareness and changes in diagnostic criteria

OBJECTIVES: To estimate the national prevalence of parent-reported autism spectrum disorder (ASD) diagnosis among US children aged 3 to 17 years as well as their treatment and health care experiences using the 2016 National Survey of Children’s Health (NSCH).

METHODS: The 2016 NSCH is a nationally representative survey of 50 212 children focused on the health and well-being of children aged 0 to 17 years. The NSCH collected parent-reported information on whether children ever received an ASD diagnosis by a care provider, current ASD status, health care use, access and challenges, and methods of treatment. We calculated weighted prevalence estimates of ASD, compared health care experiences of children with ASD to other children, and examined factors associated with increased likelihood of medication and behavioral treatment.

RESULTS: Parents of an estimated 1.5 million US children aged 3 to 17 years (2.50%) reported that their child had ever received an ASD diagnosis and currently had the condition. Children with parent-reported ASD diagnosis were more likely to have greater health care needs and difficulties accessing health care than children with other emotional or behavioral disorders (attention-deficit/hyperactivity disorder, anxiety, behavioral or conduct problems, depression, developmental delay, Down syndrome, intellectual disability, learning disability, Tourette syndrome) and children without these conditions. Of children with current ASD, 27% were taking medication for ASD-related symptoms, whereas 64% received behavioral treatments in the last 12 months, with variations by sociodemographic characteristics and co-occurring conditions.

CONCLUSIONS: The estimated prevalence of US children with a parent-reported ASD diagnosis is now 1 in 40, with rates of ASD-specific treatment usage varying by children’s sociodemographic and co-occurring conditions.

At AP, Lindsey Tanner has a very sensible report:
Various reports in recent years have suggested autism rates are rising slightly. Experts think that's mostly because of earlier diagnosis, an expanded definition and more awareness, but say they can't rule out a true increase caused by unknown factors.
How many American children have autism? The U.S. government answers that question at least three different ways and says the latest estimate — 1 in 40 kids — doesn't necessarily mean the numbers are rising.
Here's a rundown on the three surveys:

— The latest estimate is based on responses from about 43,000 parents of kids aged 3 to 17. They were asked if their child had ever been diagnosed with autism spectrum disorder, the formal name that encompasses mild to severe cases. The 2016 survey was internet-based; earlier ones were telephone surveys showing slightly higher rates but the researchers say the results aren't comparable,

The nationally representative survey suggests that about 1.5 million U.S. kids have autism — 2.5 percent or 1 in 40.

The Centers for Disease Control and Prevent collects nationally representative information from in-person interviews. In 2016, it also asked parents of kids aged 3 to 17 about an ever-diagnosis of autism and came up with a rate slightly higher than in previous years but similar to the 1 in 40 estimate.

— The CDC also uses an 11-state tracking system. It's based on health and school records showing which kids meet criteria for autism, focusing on 8-year-olds because most cases are diagnosed by that age. A report from this network released in April, showed that 1 in 59 kids have autism although much higher rates were found in some places. This estimate is considered the most rigorous, but it's not nationally representative.

Sunday, November 25, 2018

What Criminal Justice Students Know of Autism

In The Politics of Autism, I write:
People with disabilities are victims of violent crime three times as often as people without disabilities. The Bureau of Justice Statistics does not report separately on autistic victims, but it does note that the victimization rate is especially high among those whose disabilities are cognitive. A small-sample study of Americans and Canadians found that adults with autism face a greater risk of sexual victimization than their peers. Autistic respondents were more than twice as likely to say that had been the victim of rape and over three times as likely to report unwanted sexual contact.

At The Journal of Police and Criminal Psychology, Melanie Clark Mogavero has an article titled "What Do Criminal Justice Students Know About Autism? An Exploratory Study Among Future Professionals."  The abstract:
The social and communication impairments and other atypical behaviors among those with autism spectrum disorder (ASD) make this subset of the population particularly vulnerable. These vulnerabilities also present a separate set of concerns when they have contact with the criminal justice system, typically as victims or witness of abuse, as offenders or suspicious persons, or lost or missing persons. Specific measures must be taken to improve communication and to avoid misinterpreting communication impairments and other atypical behaviors as an indication of a lack of cooperation, being under the influence of substances, or of guilt/lack of remorse. Without the benefit of having basic knowledge and understanding of autism, criminal justice system professionals will struggle with meeting the needs of those with ASD. The current study explored the level of autism knowledge and awareness of among a sample of 400 undergraduate criminal justice students and possible future criminal justice professionals. The results demonstrated that the sample of students had moderate knowledge of ASD, which did not appear to increase with time in program. Those with greater exposure to people with ASD had more knowledge and understanding than those who did not. Recommendations and implications are discussed.
From the article:
Due to behavioral characteristics such as social isolation, social issues, poor communication skills, and other atypical behaviors, those with ASD are at greater risk of physical and sexual abuse (Carlile 2018; Duan et al. 2015; Edelson 2010; Hall-Lande et al. 2015; Mandell et al. 2005; Perkins and Wolkind 1991). For example, Mandell et al. (2005) reported that of the 156 children with ASD, 14% were victims of physical abuse, 12% sexual abuse, and more than 4% had been both victims of both physical and sexual abuse. An unpublished 2007 report by The Autism Society revealed that among a survey of 1500 individuals with ASD and their caregivers, 17% reported physical abuse or assault, 13% reported being the victim of sexual abuse, 8% reported a sexual assault, and 8% reported neglect (Autism Society 2006). Hall-Lande et al. (2015) noted that children with ASD and other disabilities were overrepresented in the state child protection system than children without disabilities. Further, Duan et al. (2015) noted that the severity of abuse not only increased with age, but also the severity of one’s ASD symptomology.
Unfortunately, many abuse cases go unreported and police follow-up, prosecution, and convictions of the perpetrators are low, often due to a lack of specialized police training in handling victims with developmental disabilities, and many individuals with disabilities are overwhelmed by the CJS (Gammicchia and Johnson n.d.). Victim credibility as a witness is often challenged due to concerns with memory, suggestibility, and communication (Bruck et al. 2007; Henry et al. 2017; Lindblad and Lainpelto 2011; Maras and Bowler 2010; Maras et al. 2014; Mattison et al. 2015, 2016; McCrory et al. 2007). Some parents reported that police appeared to be impatient and lacked empathy when their child had difficulty remembering events, dates, and times, which sometimes led to their child becoming too distressed to continue the interview (Edworthy and Hylton 2010).
Surveys of police officers reported that obtaining written statements or conducting interviews with individuals with ASD was difficult (Crane et al. 2016). Therefore, when police must communicate with someone with ASD, certain provisions must be implemented, beginning with the initial contact, questioning (to ensure accurate accounts of crimes are obtained), and having appropriate representation so their rights preserved. Communication provisions include adequately preparing the victim of the legal process, being aware of any communication or reading difficulties, using assistive technology when necessary, eliminating/reducing noise or other visual stimuli that could be distracting, and also limiting the number of interviews or reducing the length of interviews (Edworthy and Hylton 2010; Henry et al. 2017; Gammicchia and Johnson n.d.).

Saturday, November 24, 2018

Young Crusader Against Seclusion

In The Politics of Autismdiscuss the use of restraint and seclusion.  Many posts have mentioned these techniques, both in schools and facilities for people with disabilities.

At NBC News, Hannah Rappleye and Liz Brown report on Alex Campbell, an autistic student from Virginia whose school often put him in a seclusion room without telling his parents.
According to the latest data collected by the U.S. Department of Education, public school districts reported restraining or secludingover 120,000 students during the 2015-2016 school year, most of them children with disabilities. Families and advocates have documented cases of students being pinned down, strapped to their wheelchairs, handcuffed or restrained in other ways. Both practices, experts say, can traumatize children, and may lead to severe injuries, even death.
Alex is determined to close the seclusion rooms for good. Last week, the 13-year-old told his story to legislators, congressional staff and advocates to mark the introduction of the Keeping All Students Safe Act, a bill that would bar the use of seclusion and significantly curtail the use of restraints in schools that receive federal funds. No federal law currently regulates the use of such practices on students.
While a landmark piece of federal legislation called the Individuals With Disabilities Education Act, or IDEA, mandates that all students with disabilities are provided with a free public education tailored to meet their needs, regulations governing the use of restraint and seclusion in schools vary from state to state. Many states don't require school administrators to notify parents when their child is restrained or secluded. According to a recent analysis published by the Autism National Committee, only 28 states provide "meaningful protections against restraint and seclusion" for children, including those with disabilities.
From ASAN:
ASAN applauds Congress for the introduction of the Keeping All Students Safe Act (KASSA). If passed, the Keeping All Students Safe Act would be the first federal law to limit the use of restraints and seclusion on children with disabilities. ASAN strongly supports the swift passage of this crucial legislation.
Restraint and seclusion have a long history of overuse, especially on students with disabilities and students of color. Being restrained or secluded is a traumatic, sometimes life-threatening experience. And using restraint and seclusion doesn’t translate into better outcomes for students. In fact, research found that by abandoning restraint and seclusion, students are safer and more likely to achieve their goals. Schools are meant to support students and help them learn and grow – that isn’t possible in an environment where restraint and seclusion are used.
We recognize there is still a lot of work to be done to ensure disabled students are safe at school, and to close school to prison pipeline. While KASSA would require data collection on restraint and seclusion, the data would not show key demographic information of students who are restrained or secluded, such as the type of disability they have, or if they were both a disabled student and a student of color. Understanding which kinds of students are disproportionately restrained or secluded is an important tool for advocates, and we encourage Congress to refine the data collection guidelines within this bill to include these parameters. In addition, we urge Congress to offer more protections for students who are restrained by school resource officers (SROs), as well as close a loophole within KASSA that might inadvertently allow certain kinds of restraints.
Restraint and seclusion are horrifying practices that violate the rights of disabled students. Disabled students deserve better than restraint and seclusion, and KASSA is an important step forward that our community wants and needs. We urge Congress to pass this long-overdue bill as soon as possible, and look forward to working with them to make that happen.

Friday, November 23, 2018

Good News: Court Upholds California Vax Law Bad News: Chickenpox and Measles

Helen Christophi at Courthouse News:
Dealing a blow to vaccine opponents, a California appellate court upheld a 2016 state law repealing the personal belief exemption to California’s immunization requirements for schoolchildren.
Four California parents and a California anti-vaccine group called A Voice for Choice, Inc. sued the state’s education department over the statute last year, claiming it violated their rights to due process, privacy, a public education and free exercise of religion under the California Constitution.
But in an unpublished opinion issued Tuesday, the Sacramento-based appellate court rejected each of their claims as unsupported by case law.
Plaintiffs’ arguments are strong on hyperbole and scant on authority,” Associate Justice Ronald Robie wrote for the court’s three-judge panel, adding, “Plaintiffs’ failure to cite or even acknowledge the seminal cases (Abeel or Zucht) directly on point and counter to their argument in their opening brief violates counsel’s duty to the court.”
A release from Buncombe County, NC:
The varicella (chickenpox) outbreak at Asheville Waldorf School has grown to 36 students. Health officials continue to monitor the situation and strongly encourage everyone in the community to do their part to reduce the spread of this outbreak.

The best way to prevent becoming infected with chickenpox is to be fully immunized.

Chickenpox is easily passed from one person to another through the air by coughing or sneezing or through the fluid from a blister of a person who has chickenpox. Although it is usually not a serious illness, it often causes children and their parents to miss days at school and work. Most cases of chickenpox in healthy children are treated with bed rest, fluids, and fever control.
Deena Yellin at The North Jersey Record reports on a measles outbreak in the NY/NJ area:
The measles outbreak has continued to spread, with additional cases reported throughout New York and New Jersey. The majority of people infected with measles were not vaccinated, health officials said.

The largest outbreak is in Rockland County, which had 75 confirmed cases and 11 suspected cases as of Monday morning, the Rockland County Department of Health said.
New Jersey has 14 confirmed cases, with most of them in Lakewood in Ocean County, the New Jersey Department of Health reported.

And Brooklyn, New York, has 24 confirmed cases, the New York City Department of Health said.

Medical experts have called this the largest outbreak of the disease in decades, with measles reported in 26 states, including California, Florida, Nevada and Texas.

The illness has also been responsible for 33 deaths in EU countries in 2018, according to the European Center for Disease Prevention and Control.
The recent outbreaks in New Jersey, Brooklyn and Rockland County are linked to people who traveled to Israel and returned with the infection. In Rockland County, the cases have spread beyond the Orthodox community, where they originated. Health officials say a mix of adults, teens and children have been affected.

Thursday, November 22, 2018

CARD Opens Adult Center for Excellence

A release from the Center for Autism and Related Disorders (CARD):
Center for Autism and Related Disorders (CARD) has opened its first CARD Adult Center of Excellence (ACE), expanding its reach and reaffirming its commitment to serving the individuals with autism throughout their lives. The new center will provide a unique, positive learning and training environment for teens and adults with autism spectrum disorder (ASD). As with its over 200 existing treatment centers, CARD ACE will deliver top-quality, evidence-based behavioral health treatment while also providing an age-appropriate space that focuses on social, leisure, adaptive, and independent living skills.
In addition to traditional clinic rooms for center-based services and parent/caregiver support, and a communal room for social skills training, CARD ACE features a mock kitchen, bedroom, laundry room, and office for independent, adaptive, and vocational skills development.
“We are excited to open the doors to the CARD Adult Center of Excellence to the autism community in Southern California,” said CARD Adults program manager Vanessa Alvarez. “This new location will provide invaluable services and resources to those who need a more mature setting to develop the skills that will help them increase their independence and pursue their social and vocational goals.”
“The Adult Center of Excellence is a natural progression for CARD, just as our CARD community will naturally graduate from adolescence to young adulthood,” added Doreen Granpeesheh, PhD, BCBA-D, founder of CARD. “We realize that navigating the unique challenges of autism does not end with childhood, and we are honored to be there with our patients as they grow and gain the skills that support them in adulthood.”
The center is located at 931 Buena Vista Street, Suite 200, Duarte, CA 91010. For more information, please contact CARD Adults program manager Vanessa Alvarez at v.alvarez(at)
About Center for Autism and Related Disorders (CARD)
CARD treats individuals of all ages who are diagnosed with autism spectrum disorder (ASD) at treatment centers around the globe. CARD was founded in 1990 by leading autism expert and licensed psychologist Doreen Granpeesheh, PhD, BCBA-D. CARD treats individuals with ASD using the principles of applied behavior analysis (ABA), which is empirically proven to be the most effective method for treating individuals with ASD and recommended by the American Academy of Pediatrics and the US Surgeon General. CARD has over 200 locations throughout the United States. For more information, visit

Wednesday, November 21, 2018

Parents' Hopes for Transition-Age Youth

In The Politics of Autism, I write:
When disabled people reach their 22d birthday, they no longer qualify for services under IDEA. ... People in the disability community refer to this point in life as “the cliff.” Once autistic people go over the cliff, they have a hard time getting services such as job placement, vocational training, and assistive technology. IDEA entitles students to transition planning services during high school, but afterwards, they have to apply as adults and establish eligibility for state and federal help. One study found that 39 percent of young autistic adults received no service at all, and most of the rest got severely limited services.
Researchers have documented that young adults with autism spectrum disorder have poor outcomes in employment, post-secondary education, social participation, independent living, and community participation. There is a need to further explore contributing factors to such outcomes to better support successful transitions to adulthood. Parents play a critical role in transition planning, and parental expectations appear to impact young adult outcomes for autistic individuals. The aim of this study was to explore how parents express their future visions (i.e. hopes and expectations) for their autistic transition-age youth. Data were collected through focus groups and individual interviews with 18 parents. Parents’ hopes and expectations focused on eight primary domains. In addition, parents often qualified or tempered their stated hope with expressions of fears, uncertainty, realistic expectations, and the perceived lack of guidance. We discuss our conceptualization of the relations among these themes and implications for service providers and research.
The eight domains and examples:

  • Community mobility: Ability to access and navigate the community, through public or private transportation "But my hope for next year will be that he’ll have learned how to drive, will get some way, shape, or form an access to a car, and that he can transport himself to and from [school] and/or work, and/or community college …" (Vicky) 
  • Community participation: Engagement in the community includes; community-based activities and social interaction with individuals/groups in the community "So that’s one of the goals we’re having actually right now at school … helping him learn how to interact with … the cashier at the store … they practiced beforehand how to make small talk while paying for your item instead of just looking at the floor or something … Those are really important things that I want him to get used to." (Sarah) 
  • Living situation: Where the youth will live in the future "Robert isn’t ready to live away yet, but that is our goal. The plan is for him to be able to go and participate someplace where he can gain the independence that he needs in order to be as independent as possible." (Judy) 
  • Peer Relationships: Friendships; relationships with peer groups "My vision for him in five years is that he has a best friend. Honestly. That’s my vision for him. I think if he didn’t go to college or anything else, for [my son] to have a best friend would be amazing. "(Christine) 
  • Personal safety: Safety from physical or emotional harm; ability to avoid, prevent, and/or adequately respond to hazardous situations and environments "I would pretty much say that if you ask any parent, safety’s going to be first. More so than folding the laundry, safety. My son has absolutely no sense at all." (Melanie) 
  • Post-secondary education: Enrollment in college or university-level courses "Five years, graduate high school … definitely graduate, he wants to graduate when he’s a senior. And then maybe take some college courses and work part time … I don’t think he could ever go to college independently full-time, like go live in a dorm. So get him into some type of, you know, supported college. He wants to get his college degree." (Sharon) 
  • Self-care: Taking care of oneself, including physical health (e.g. maintaining diet/medications), emotional well-being (e.g. happiness), and life skills (e.g. cooking, brushing teeth) "… One of the things that’s really important for us too is … health and well-being … being physical, going to the gym, doing what everyone else does to stay healthy. Because he has a very limited diet, and again that makes it very hard for him to live on his own because if you only eat peanut butter sandwiches … I mean you can survive! But that’s not healthy."(Jodie) 
  • Work: Commitment to work; paid or unpaid; part-time, full-time, or temporary; volunteering, internships, or vocational training "That would be my number one goal—to have Lauren have some kind of meaningful work. I really don’t know what that will look like in five years or how capable she’ll be. She’s got a long way to go, working at a [pet store], or being a pet groomer, having her own pet-sitting business, something like that, is probably my number one goal."(Tracy)

Tuesday, November 20, 2018

Nitric Oxide

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

Key Points
Question  Is prenatal exposure to air pollution a risk factor for autism spectrum disorder? Findings  In this population-based cohort study of 132 256 births, maternal exposure to nitric oxide during pregnancy was associated with increased risk of autism spectrum disorder in offspring.
Meaning  Reducing exposures of pregnant women to environmental nitric oxide may be associated with a reduction in autism spectrum disorder incidence in their children.
Importance  The etiology of autism spectrum disorder (ASD) is poorly understood, but prior studies suggest associations with airborne pollutants.
Objective  To evaluate the association between prenatal exposures to airborne pollutants and ASD in a large population-based cohort.
Design, Setting, and Participants  This population-based cohort encompassed nearly all births in Metro Vancouver, British Columbia, Canada, from 2004 through 2009, with follow-up through 2014. Children were diagnosed with ASD using a standardized assessment with the Autism Diagnostic Interview–Revised and Autism Diagnostic Observation Schedule. Monthly mean exposures to particulate matter with a diameter less than 2.5 µm (PM2.5), nitric oxide (NO), and nitrogen dioxide (NO2) at the maternal residence during pregnancy were estimated with temporally adjusted, high-resolution land use regression models. The association between prenatal air pollution exposures and the odds of developing ASD was evaluated using logistic regression adjusted for child sex, birth month, birth year, maternal age, maternal birthplace, and neighborhood-level urbanicity and income band. Data analysis occurred from June 2016 to May 2018.
Exposures  Mean monthly concentrations of ambient PM2.5, NO, and NO2 at the maternal residence during pregnancy, calculated retrospectively using temporally adjusted, high-resolution land use regression models.
Main Outcomes and Measures  Autism spectrum disorder diagnoses based on standardized assessment of the Autism Diagnostic Interview–Revised and Autism Diagnostic Observation Schedule. The hypothesis being tested was formulated during data collection.
Results  In a cohort of 132 256 births, 1307 children (1.0%) were diagnosed with ASD by the age of 5 years. The final sample size for the PM2.5-adjusted model was 129 439 children, and for NO and NO2, it was 129 436 children; of these, 1276 (1.0%) were diagnosed with ASD. Adjusted odds ratios for ASD per interquartile range (IQR) were not significant for exposure to PM2.5 during pregnancy (1.04 [95% CI, 0.98-1.10] per 1.5 μg/m3 increase [IQR] in PM2.5) or NO2 (1.06 [95% CI, 0.99-1.12] per 4.8 ppb [IQR] increase in NO2) but the odds ratio was significant for NO (1.07 [95% CI, 1.01-1.13] per 10.7 ppb [IQR] increase in NO). Odds ratios for male children were 1.04 (95% CI, 0.98-1.10) for PM2.5; 1.09 (95% CI, 1.02-1.15) for NO; and 1.07 (95% CI, 1.00-1.13) for NO2. For female children, they were for 1.03 (95% CI, 0.90-1.18) for PM2.5; 0.98 (95% CI, 0.83-1.13) for NO; and 1.00 (95% CI, 0.86-1.16) for NO2.
Conclusions and Relevance  In a population-based birth cohort, we detected an association between exposure to NO and ASD but no significant association with PM2.5 and NO2.

Monday, November 19, 2018

Consequences of Vaccine Exemptions: Chickenpox and Measles

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

Isaac Stanley-Becker at The Washington Post:
Chickenpox has taken hold of a school in North Carolina where many families claim religious exemption from vaccines.
Cases of chickenpox have been multiplying at the Asheville Waldorf School, which serves children from nursery school to sixth grade in Asheville, N.C. About a dozen infections grew to 28 at the beginning of the month. By Friday, there were 36, the Asheville Citizen-Times reported.
The outbreak ranks as the state’s worst since the chickenpox vaccine became available more than 20 years ago. Since then, the two-dose course has succeeded in limiting the highly contagious disease that once affected 90 percent of Americans — a public health breakthrough.
The school is a symbol of the small but strong movement against the most effective means of preventing the spread of infectious diseases. The percentage of children under 2 years old who haven’t received any vaccinations has quadrupled since 2001, according to the Centers for Disease Control and Prevention.
Like the Disneyland measles outbreak in 2015, the flare-up demonstrates the real-life consequences of a shadowy debate fueled by junk science and fomented by the same sort of Twitter bots and trolls that spread misinformation during the 2016 presidential election. And it shows how a seemingly fringe view can gain currency in a place like Asheville, a funky, year-round resort town nestled between the Blue Ridge and Smoky Mountains.
Chickenpox spreads fast and can have very serious effects.
But not all parents seemed to grasp the gravity of the outbreak. Nor does everyone see the rationale behind vaccines, which some believe — contrary to scientific evidence — cause more severe health issues than they’re meant to cure. The claim of an autism risk, though it has been debunked, has remained a rallying cry of the anti-vaccine movement.

Antivax organizations such as Texans For Vaccine Choice are push exemptions for students in public schools, and they are also says that state-regulated day care centers should be subject to the same exemptions. An editorial in The Dallas Morning News says "That's madness."
Applying the personal exemption standard to child care facilities would be a dangerous road to take. The CDC recommends that children do not start to get vaccines for measles until they reach at least 12 months of age. Should parents have to risk their kids getting the measles at such a young age from older, unvaccinated children? We don’t believe so.
Texas was one of 25 states last year to report cases of the measles. Medical experts and researchers say that the continued growth in the number of parents not getting their children vaccinated is increasing the risk of a measles outbreak. One doctor said, “It is really not a question of whether these outbreaks will occur but when.”
We should be thankful that technology and medical advances managed to bring us out of the dark ages. It’s remarkable that in the early 1960s, measles cases numbered in the hundreds of thousands. By the early 1990s, measles practically vanished. Now, it’s slowly starting to make a comeback.
Texans For Vaccine Choice is only trying to make things worse, and their position that personal exemptions are allowed for child care facilities is something Texans cannot accept.

Sunday, November 18, 2018

The Autism Caucus Lost Many Members in This Cycle

In The Politics of Autism, I discuss the congressional role in the issue.

The Autism Caucus lost about one-fifth of its House members as a result of retirement, resignation, defeat, or election to other office.

Robert A. Brady (D) (Pennsylvania, District 01) retiring
Michael E Capuano (D) (Massachusetts, District 07) lost primay
Mike Coffman (R) (Colorado, District 06) lost general election
Barbara Comstock (R) (Virginia, District 10) lost general election
Ryan Costello (R) (Pennsylvania, District 06) retiring
Joseph Crowley (D) (New York, District 14) lost primary
John J Duncan Jr. (R) (Tennessee, District 02) retiring
Bob Goodlatte (R) (Virginia, District 06) retiring
Trey Gowdy (R) (South Carolina, District 04) retiring
Gene Green (D) (Texas, District 29) retiring
Darrell Issa (R) (California, District 49) retiring
Sander Levin (D) (Michigan, District 09) retiring
Jason Lewis (R) (Minnesota, District 02) lost general election
Frank LoBiondo (R) (New Jersey, District 02) retiring
Thomas MacArthur (R) (New Jersey, District 03) lost general election
Patrick Meehan (R) (Pennsylvania, District 05) resigned
Luke Messer (R) (Indiana, District 06) lost primary
Rick Nolan (D) (Minnesota, District 08) retiring
Erik Paulsen (R) (Minnesota, District 03) lost general election
Ileana Ros-Lehtinen (R) (Florida, District 27) retiring
Pete Sessions (R) (Texas, District 32) lost general election
Scott W Taylor (R) (Virginia, District 02) lost general election
Pat Tiberi (R) (Ohio, District 12) resigned
Tim Walz (D) (Minnesota, District 01) elected governor of Minnesota
Kevin Yoder (R) (Kansas, District 03) lost general election

In the Senate, Democrat Joe Donnelly of Indiana lost the general election

Kyrsten Sinema (D) (Arizona, District 09) left her House seat to run for the Senate, where she will probably remain in the Caucus.

Saturday, November 17, 2018

The West and the Antivax Movement

At The Conversation, Dr. Peter Hotez writes about the antivax movement.
Together with colleagues from Baylor College of Medicine and Texas Children’s Hospital, where I work, we did an in-depth study of kindergarten schoolchildren who receive vaccine exemptions across the country. Currently, 18 states allow nonmedical vaccine exemptions for either “conscientious objector” or “philosophical/personal belief” reasons. We were able to obtain information on 14 of those states.
A clear picture emerged: Vaccine exemptions are on the rise in 12 of the states we looked at. Indeed, anti-vaccine activities appear to be more of a western phenomenon, especially in the Pacific Northwest (Idaho, Oregon and Washington) and the American Southwest (Arizona, Missouri, Oklahoma, Texas and Utah).
What exactly is going on in the West, where many parents shun vaccines and take their children out of vaccination programs? Researchers are still at the early stages of understanding the reasons behind the anti-vaccine movement. A couple of these states, Oklahoma and Texas, host well-organized political action committees that lobby their legislatures and even raise campaign funds for candidates to endorse anti-vaccine positions. These committees appeal to parental fears of unwarranted government interference.
What’s more, some studies suggest that vaccine refusal is linked to affluence, and possibly with affluence there is greater access to the internet. There are now hundreds of anti-vaccine websites on the internet, many of which still allege that vaccines cause autism or that autism is a form of “vaccine injury,” neither of which is true.
The anti-vaccine movement also effectively uses social media to share their message. Some studies show that anti-vaccine social media has created an “echo chamber” effect that strongly reinforces negative attitudes towards vaccines.

Friday, November 16, 2018

Keeping All Students Safe Act

In The Politics of Autismdiscuss the use of restraint and seclusion.  Many posts have mentioned these techniques, both in schools and facilities for people with disabilities.

A release from Senator Chris Murphy (D-CA):
U.S. Senator Chris Murphy (D-Conn.), a member of the U.S. Senate Health, Education, Labor, and Pensions (HELP) Committee, joined U.S. Representatives Don Beyer (VA-8) and Bobby Scott (VA-3), ranking member of the U.S. House of Representatives Committee on Education and the Workforce, and U.S. Senator Patty Murray (D-Wash.), ranking member of HELP, on Wednesday in introducing the Keeping All Students Safe Act to protect students from the dangers of seclusion and restraint at school.

The legislation would make it illegal for any school receiving taxpayer dollars to seclude children. The legislation also limits the use of physical restraint to instances when it is necessary for the safety of students and teachers. The bill would establish minimum safety standards in schools, require states to monitor the law’s implementation, and increase transparency and oversight to prevent future abuse of students.
The legislation refers to key facts and findings that reveal a concerning history of seclusion and restraint of students in schools, including a 2009 Government Accountability Office (GAO) investigation that revealed hundreds of incidents of child abuse in schools as a result of seclusion and restraint practices that disproportionately impacted children with disabilities and children of color.
FACT SHEET: Keeping All Students Safe Act
SECTION BY SECTION: Keeping All Students Safe Act

Thursday, November 15, 2018

Public Charge

In The Politics of Autism, I explain how the issue connects with so many other issues.  Immigration is an example.

Zaidee Stavely at EdSource:
Hundreds of thousands of immigrant parents in California may disenroll their children from health insurance, food stamps and other federally subsidized programs because they fear that receiving these benefits will make it impossible for them to become permanent residents in the United States.
Their fears have been triggered by new regulations proposed by the Trump administration that expand the number of benefits that immigration officers can take into account in deciding whether to deny an immigrant permanent residence in the United States. Federal law allows immigration officials to deny green cards to immigrants if authorities decide they are likely to become a “public charge” — someone who relies excessively on government benefits to survive.

The draft regulations are currently open for public comments until Dec. 10th.
Administrators at community clinics, school-based health centers and agencies serving children say some parents in California are already choosing not to enroll or withdrawing their children from health and nutrition programs.
A parent asked First 5 Alameda, an agency that supports families with small children, to stop seeking early intervention services from a local school district for their toddler with autism.

Wednesday, November 14, 2018

House Committees

The Autism Society explains how the switch to Democratic control will affect committees in the House of Representatives:
Budget and Appropriations
Rep. John Yarmuth of Kentucky will likely take the helm of the Budget Committee. This committee has jurisdiction over the budget resolution. The change likely means the budget will not be used to force changes to important programs like Medicaid, Medicare and Social Security. Yarmuth has said he hopes to mark up a fiscal 2020 budget resolution that will reflect Democratic spending priorities such as infrastructure, education, job training, and clean energy.
Rep. Nita Lowey of New York is slated to chair the powerful Appropriations Committee. This committee decides where the money allocated from the Budget Resolution will be used to fund specific programs. The Subcommittee on Labor, HHS, Education will be chaired by Rep. Rosa DeLauro of Connecticut. This committee has jurisdiction over spending decisions most autism and other disability programs.
Energy and Commerce/Health Care
Rep. Frank Pallone Jr. of New Jersey is in line to be the next chairman of the Energy and Commerce Committee currently led by Rep. Greg Walden of Oregon. This Committee works on important issues like health care, including Medicaid. Under the leadership of Pallone, the House will push back on any attempts to repeal the Affordable Care Act or to make cuts to Medicaid; and could introduce bills to strengthen the ACA marketplaces and begin reviewing bills to provide universal health care. Rep. Pallone is also the author of a bill to provide long-term care to seniors and people with disabilities that may now get attention by the committee. This committee will also be responsible for reauthorizing the Autism CARES Act, one of the Autism Society’s biggest priorities for 2019 when the law is set to expire.
Ways and Means
The Chairmanship of the Ways and Means Committee will likely be Richard Neil of Massachusetts. This committee is responsible for tax and some health care programs. It is unclear at this time what tax bills will be considered. On health, top priorities include shoring up the Affordable Care Act exchanges and lowering the cost of prescription drugs. The retirement of Rep. Sander M. Levin (D-MI), opens up the top spot on the Health Subcommittee. California Rep. Mike Thompson is currently the panel’s most senior member and likely to take that seat.
Education and the Workforce
Rep. Robert Scott of Virginia is expected to chair the Education and Workforce Committee. This committee will be responsible for the reauthorization of the Higher Education Act (HEA) and any other education and employment bills. Scott authored an HEA bill (AIM Higher Act) that would promote the inclusion of students with autism. This committee will also likely to take up a bill to reduce the use of restraints and seclusion in schools. Bipartisan bills in development related to increasing opportunities for competitive, integrated employment may also be considered in this committee in the new Congress. Rep. Virginia Foxx of North Carolina is expected to remain on the committee as the ranking minority member.
Judiciary Committee
Rep. Jerrold Nadler of New York is poised to become the next chairman of the Judiciary Committee. This committee has jurisdiction over our civil rights laws, including the Americans with Disabilities Act. Nadler was an opponent of HR 620, a bill that would weaken the ADA.