Russian Antivax Efforts, 2020

In The Politics of Autism, I look at the discredited notion that vaccines cause autism.  Russian trolls have spread the myth via social media.  They are also spreading other vaccine disinformation.  Antivaxxers are doing Putin's work for him.

Amanda Seitz at AP:

A false report claiming five Ukrainians had died after taking an American-made coronavirus vaccine spread in just a matter of days from a small Kremlin-friendly website to an audience of thousands in U.S.-based Facebook groups.

Russian media outlets picked up the claim, and soon social media users in the U.S. were sharing screenshots and links to those articles — all as 30,000 Americans were preparing to roll up their sleeves for shots of an experimental COVID-19 vaccine late last month.

The fast dissemination of a single report from an obscure Ukrainian website to crowds of Facebook users highlights the ease with which pro-Russian websites can feed misinformation into American internet circles. In fact, one of the websites that picked up the report was identified by the U.S. State Department this week as being part of a network of proxy misinformation websites being used by the Russian government.

As various countries race to produce a successful coronavirus vaccine, disinformation experts are bracing for a steady drum of misleading claims and propaganda aimed at undermining competing countries’ efforts to develop an antidote. Misinformation could raise distrust and fear around a vaccine, threatening government leaders’ hopes of ending the pandemic. And the U.S., which is readying plans to deliver 300 million doses to Americans starting next year, if a successful vaccine is identified, could be a prime target.

Trends in Childhood Disability

A release from the University of Pittsburgh Medical Center:

The percentage of children with disabilities due to neurodevelopmental or mental health conditions continues to rise, particularly among children in more socially advantaged households, according to a Children’s Hospital of Pittsburgh of UPMC analysis that appears in the September issue of Pediatrics.

Results of the study, led by Amy Houtrow, M.D., Ph.D., M.P.H., chief, Division of Pediatric Rehabilitation Medicine at Children’s Hospital, found that while there has been a decline in physical health-related disabilities by approximately 12 percent, there was a large, nearly 21 percent rise in disabilities classified as neurodevelopmental or mental health in nature.

The researchers studied data from the National Health Interview Survey conducted by the U.S. Centers for Disease Control and Prevention between 2001 and 2011, evaluating each child’s ability to perform activities at home and school.

Although children living in poverty have the highest rates of disability, children living in families at or above 400 percent of the federal poverty level reported a 28.4 percent increase in disabilities over the past 10-year period.

Dr. Houtrow and the researchers offered four reasons that may explain the increased rates of disability related to neurodevelopmental or mental health conditions:

• shifts in diagnostic criteria
• overall increases in rates of certain problems including autism
• increased awareness of these conditions
• the need for a specific diagnosis to receive services such as early intervention 

“This study demonstrates what a lot of pediatricians have been noticing for several years – that they are seeing more neurodevelopmental and mental health problems in their clinical practices,” said Dr. Houtrow, who also is an associate professor of Physical Medicine & Rehabilitation and Pediatrics and vice chair in the University of Pittsburgh School of Medicine’s Department of Physical Medicine and Rehabilitation. “As we look toward the future, the pediatric health care workforce and system needs to adapt to assure the best possible health and functional outcomes for children with disabilities related to neurodevelopmental and mental health conditions.”

More on Life After High School

The study by Shattuck et al. on postsecondary outcomes also casts a light on poverty and inequality.  From the study (full text and abstract are currently online for free):

Youth from households with lower incomes also were significantly more likely to be disengaged, even after controlling for measures of impairment severity. This finding highlights the value of using population-based data relative to smaller clinical samples that often lack diversity. It also builds on previous findings in another examination of youth with an ASD after high school that found those with lower socioeconomic status had poorer behavioral outcomes after high school. The association between a lack of financial resources and poorer postsecondary outcomes among youth with an ASD also mirrors previous findings that found African-American individuals and those from poorer households to be at increased risk for disengagement from therapeutic services after leaving high school.

An emerging pattern of findings across a range of outcome measures suggests poorer youth with an ASD have very different life chances after leaving high school than more affluent peers. Income inequality and poverty rates have been increasing nationwide in recent years. In 2009, 20% of US children lived below the federal poverty line. Given current estimates of ASD prevalence and the poverty rate, ∼163 000 children with an ASD were living below the poverty line in 2009. Future research needs to examine how financial resources influence developmental trajectories and what interventions are needed to help poorer youth overcome barriers to accessing services and achieving fuller participation in society.

Social Class and Trajectories

Dr. Claire McCarthy writes at The Boston Globe:

A study just came out with some very interesting information about how children with autism do or don't get better over time. Guess which ones did better?

The ones whose mothers were white and educated.

It's true. Researchers looked at the records of more than 6000 children ages two to 14 with autism followed by the Department of Developmental Services in California. They found that for the most part, even though they made progress, children who were low-functioning when they were diagnosed stayed low-functioning. Children who were high-functioning at diagnosis made more progress. And then there was a really interesting group, about ten percent of the children, who they called "Bloomers". Bloomers started out low-functioning, and then made rapid progress and ended up as high-functioning.

The researchers also had birth data about the children, which gave them information about the mothers: their age, place of birth, race, education level, and whether or not they were on Medi-Cal, the public insurance for low-income people. This is where it got really interesting. The researchers found that:

• Low-functioning children were more likely to have mothers who were minority/foreign born, less educated, and on Medi-Cal
• High-functioning children were more likely to have mothers who were white, more educated, and not on Medi-Cal
• Bloomers were more likely to have mothers who were white and educated.

Disparities in California

In the second part of his autism series in The Los Angeles Times, Alan Zarembo shows that educated parents get more services for their kids:

For autistic children 3 to 6 — a critical period for treating the disorder — the state Department of Developmental Services last year spent an average of $11,723 per child on whites, compared with $11,063 on Asians, $7,634 on Latinos and $6,593 on blacks.

Data from public schools, though limited, shows that whites are more likely to receive basic services such as occupational therapy to help with coordination and motor skills.

The divide is even starker when it comes to the most coveted service — a behavioral aide from a private company to accompany a child throughout each school day, at a cost that often reaches $60,000 a year.

In the state's largest school district, Los Angeles Unified, white elementary school students on the city's affluent Westside have such aides at more than 10 times the rate of Latinos on the Eastside.

It might be tempting to blame such disparities on prejudice, but the explanation is more complicated.

“Part of what you're seeing here is the more educated and sophisticated you are, the louder you scream and the more you ask for,” said Soryl Markowitz, an autism specialist at the Westside Regional Center, which arranges state-funded services in West Los Angeles for people with developmental disabilities.

...

In California last year, autism accounted for one tenth of special education enrollment but one third of the disputes between schools and parents on record with the state.

Carmen Carley, a professional advocate for families seeking public services, said parents who present themselves as formidable opponents fare best.

“Wear a fake diamond ring,” she tells mothers who don't have a real one. “Make them think you're ready to fight. Don't show them you're weak. Don't show them you're tired.”

...

Though all regional centers are supposed to follow the same criteria, average spending per child varies widely from place to place and race to race, according to data obtained by The Times under the California Public Records Act.

Last year, the system served 16,367 autistic children between the critical ages of 3 and 6, spending an average of $9,751 per case statewide. But spending ranged from an average of $1,991 per child at the regional center in South Los Angeles to $18,356 at the one in Orange County.

At 14 of the 21 centers, average spending on white children exceeded that for both blacks and Latinos.

...

At the Frank D. Lanterman Regional Center, which serves a swath of Los Angeles County stretching from Hollywood to Pasadena, spending on white youngsters with autism averaged $12,794 per child last year — compared with $9,449 for Asians, $5,094 for blacks and $4,652 for Latinos.

Diane Anand, the executive director, said many minority children enrolled in the system receive few or no services because their parents can't participate as required in orientations or therapy sessions.

Anand faulted state officials for failing to research the causes of the disparities.

“I don't know what you do about some of this,” she said. “This is an issue that has bedeviled our service system for years and years.”

Minorities and Special Ed

Beth Winegarner reports at The San Francisco Examiner about racial disparities in special-ed classrooms:

Higher-than-expected numbers of black students also show up among those with learning disabilities, along with Hispanic students, who also cluster in the “speech and language impairment” category.

This disproportionality is not new. In 1971, black students fought the SFUSD’s use of racially biased IQ tests to sequester them in classes for “educable mentally retarded” students. The tests were banned, but black and Hispanic students still wind up in special-education classrooms at higher rates than their white or Asian peers.

Statewide, the SFUSD was one of 61 of the state’s 838 school districts with disproportionate numbers of black and Hispanic students in special education in the 2008-09 school year, and one of 42 that violated state special-education policies, according to a report from the California Department of Education.

“There’s institutional racism there,” said Katy Franklin, a member of the SFUSD Community Advisory Committee for Special Education. “When a white kid throws a chair they think, ‘Autistic.’ When a black kid does this, they’re labeled emotionally disturbed. I don’t think it’s deliberate; it’s just what happens.”

The problem may not be just one of labeling. Colin Ong-Dean, Alan J. Daly and Vicki Park have an article titled "Privileged Advocates" in the journal Policy Futures in Education. From the abstract:

Since the establishment of educational rights for children with disabilities in the 1970s, special education in the US has included a growing share of students and has constituted an ever-growing share of education budgets. Previous research has focused on the disproportionate assignment to special education of low-income and minority students, concluding that special education mainly reproduces social disadvantages. This article argues that privileged parents - by virtue of their ability to navigate complex legal and scientific practices and discourses that are seen as guarantees of fairness and neutrality in special education - are able to secure advantageous resources for their children through special education. Through analysis of the distribution and content of 'due process' hearing requests in the California special education system, this article shows how advocacy in this part of the system depends on parents' cultural and economic capital. Specifically, reimbursement claims in due process hearings show how having economic capital can be used to leverage public education resources, while parents' testimony in hearings shows the importance of having cultural capital. In concluding, the emphasis on parental involvement in both regular and special education is discussed and alternatives to the individualized system of rights in special education are considered.

Autism and Income

Previous posts (here and here, for instance) have discussed possible links between economics status and ASD diagnoses. The Salt Lake Tribune reports:

A new study found no association between how much Utah families earn and their children’s risk of being diagnosed with intellectual disabilities and autism spectrum disorders.

That finding, published Thursday in the journal Autism Research, contradicts earlier studies that suggested links between autism and higher income, and between intellectual disabilities and lower income.

Judith Pinborough-Zimmerman, assistant research professor at the University of Utah Department of Psychiatry, and colleagues used census data to analyze 26,108 8-year-olds born in Salt Lake, Davis and Utah counties in 1994.

They examined the gender and ethnicity of the children, the age and education levels of the parents, and how household income changed over eight years, comparing families who had a child with autism or an intellectual disability to the general population.

They found "no clear association" between income and the risk for autism or intellectual disabilities. The Centers for Disease Control and Prevention believes that by age 8, most children with autism have been diagnosed.

One issue researchers may need to examine: "Are Utah’s higher rates [of autism] in part because we are providing good services for various income groups?" Pinborough-Zimmerman said.

Diagnosis Gap Narrow -- But Does Not Close

A press release from the American Sociological Association:

Study: Socioeconomics Playing Reduced Role in Autism Diagnoses
But Poor Children From Low-Income Neighborhoods are Still Underdiagnosed

WASHINGTON, DC, April 6, 2011 — While there is an increasing equality in terms of the likelihood that children from communities and families across the socioeconomic spectrum will be diagnosed with autism, a new study finds that such factors still influence the chance of an autism diagnosis, though to a much lesser extent than they did at the height of rising prevalence.

“As knowledge has spread about autism, information is now more evenly distributed across different kinds of communities,” said Peter S. Bearman, the Cole Professor of the Social Sciences at Columbia University and the Director of the Paul F. Lazarsfeld Center for the Social Sciences, who coauthored the study, which appears in the April issue of the American Sociological Review. “It is also easier to find someone who can diagnose autism, so we no longer see these huge differences in rates of diagnosis. However, it appears that poor kids living in poor neighborhoods still are not being diagnosed.”

The study examines birth and diagnostic records for all children born in California between 1992 and 2000 in conjunction with individual and community-level data such as parental wealth, parental education, and neighborhood property value. All children were followed from the time of birth until June 2006 to allow ample time for diagnosis. As the disorder became increasingly well-known, the average age of autism diagnosis fell from 5.9 among those children born in 1992 to 3.8 for those born in 2000.

“At the height of rising prevalence, which involved children born between 1992 and 1995, kids whose parents had fewer economic resources simply weren’t diagnosed as often as wealthier children— wealthier kids were 20 to 40% more likely than poorer children to be diagnosed,” said study coauthor Marissa D. King, an assistant professor of Organizational Behavior at Yale University’s School of Management “Among children born in 2000, however, parental wealth alone had no effect on the likelihood that a child would be diagnosed.”

Overall, of the 4,906,926 million children born in California between 1992 and 2000, 18,731 or .38% were diagnosed with autism. The prevalence of autism among the 1992 through 2000 California birth cohorts increased significantly, from 29 per 10,000 in 1992 to 49 per 10,000 in 2000.

“I think what has happened in California is that the ascertainment machinery—a combination of diffusion of information, awareness, conversations, and the capacity of physicians, teachers, nursery school providers, nurses, and so on—has become more established,” Bearman said. “And, as more and more people are diagnosed with autism and the disorder becomes more central to thinking about child development in everyday discourse, the information about who might have autism is more evenly distributed across the whole state no matter where people live. So, the differences across communities and by social class are less than they used to be.”

But, Bearman said, it is still the case that children from low-income families who live in poor neighborhoods are less likely to be diagnosed with autism. “We know that parents talking to each other about navigating the service system and talking to each other about how to understand developmental dynamics are really strongly associated with increased autism diagnoses,” Bearman said. “The guess is that in wealthier neighborhoods, there are more opportunities for parents to be talking to each other at parks, schools, and other focal points.”

According to the study, on average among children born between 1992 and 2000, a child from a poor family that lived in a more affluent neighborhood was close to 250% more likely than a child from an equally disadvantaged family living in a poorer neighborhood to be diagnosed with autism.

The study also found that when autism cases were split by severity, a striking pattern was revealed—less severe cases were disproportionately found in wealthier and more educated neighborhoods. Among kids born in 1992, the odds of children with less-severe symptoms being diagnosed was 90% higher if they lived in a wealthy neighborhood. By the end of the study, that percentage had decreased by half, to 45%.

“Less severe cases, the kids who are the highest functioning, can often slip underneath the diagnostic radar in less affluent communities where the diagnostic resources are not as established,” Bearman said. “If you’re less severe, you might not be diagnosed because you don’t seem to have a profound disability—so you’re just thought to be a weird kid.”

As for policy implications of the study, Bearman said it is very simple. “I think you would like to reduce health disparities,” he said. “So, in order to reduce the health disparity—or really the service disparity—we would need to allocate more resources to increase ascertainment to get children into treatment.”

While the study focuses on children from California, the authors expect somewhat more amplified socioeconomic effects on autism diagnoses in other parts of the United States. “Since California has a state-wide program dedicated to serving kids with developmental disorders, it is likely that the inequalities in autism diagnoses are greater in other states,” King said.

###

Autism, Minnesota, and The Matthew Effect

"Whoever has will be given more, and he will have an abundance. Whoever does not have, even what he has will be taken from him." (Matthew 3:12, NIV).

This passage from the New Testament sums up the experience of ASD people receiving government services, whether from schools (as Colin Ong-Dean documents) or from other agencies. Families with money, education, and connections can work the system to get more. Those without these resources -- even though their needs may be greater -- often get less.

Maura Lerner writes at The Minneapolis Star-Tribune:

Rep. Jim Abeler, R-Anoka, introduced legislation Wednesday calling on the commissioner of human services to review a policy that critics have called a double standard.

The Star Tribune reported earlier this week that the state Medicaid program has subsidized a costly and intensive autism treatment for some affluent families while denying it to low-income children in its managed-care plans.

The treatment, known as Applied Behavior Analysis, can cost up to $100,000 a year.

"We were told Medicaid doesn't pay [for it]," said Abeler, chair of the House Health and Human Services Finance Committee. "We need to do it equitably, either all or none."

The House voted Thursday to approve health legislation that includes Abeler's amendment, which calls on the state "to extend the same autism treatment benefits" to all children in Medicaid programs.

From the original story:

Two years ago, a single mother in the Twin Cities asked the state Medicaid program to pay for an intensive type of autism therapy for her 2-year-old son.

She was turned down. State officials said the treatment -- known as Applied Behavior Analysis, or ABA -- is "not now, and never has been,'' a covered service.

It turns out, though, that's not the whole story.

For years, Minnesota taxpayers have been subsidizing that same treatment, which can cost up to $100,000 a year, for middle-class and even wealthy families, including the children of lawyers and business executives

...

Since the 1990s, a number of Minnesota families have found a way to get ABA therapy at taxpayer expense, says Dr. Eric Larsson, one of the pioneers of ABA therapy in Minnesota and founder of the Lovaas Institute Midwest, an autism treatment center in Minneapolis.

From the start, he said, they were mostly families with the money and persistence to fight for what they wanted.

They would apply for Medicaid coverage for their children through a special disability program, specifically for families above the poverty level. To get in, the child must be certified as disabled, and parents are required to pay a sliding fee (up to 13.5 percent of income).

Initially, Larsson said, the state rejected most of their requests to pay for ABA therapy -- which can involve up to 40 hours a week of treatment. But on appeal, he said, "every family that could afford an attorney won."

Eventually, it became common knowledge within certain circles that Medicaid would pay for ABA under the billing code for "skills training."

In fact, said Dawson, state officials certified those programs and told them what billing codes to use. "They know they use the ABA method, and they routinely pay those bills."

Economic Class and Autism

The New York Times "Freakonomics" blog reports:

The higher rates of diagnosed autism among the wealthy has long been thought to be a result of higher rates of diagnosis (or “diagnostic ascertainment bias”) – i.e., wealthier families having better access to those who diagnose autism. However, a new paper argues that the disease itself might actually be more common at the higher end of the income spectrum. The paper relied on “abstracted data from records of multiple educational and medical sources to determine the number of children who appear to meet the ASD case definition, regardless of pre-existing diagnosis. Clinicians determine whether the ASD case definition is met by reviewing a compiled record of all relevant abstracted data.” Within all ethnic groups, wealthier parents were more likely to have autistic children, and the pattern held for undiagnosed autistic children as well. Neuroskeptic hypothesizes that paternal age may be partially responsible for the disparity. (HT: Marginal Revolution)

The paper is here.

See also an article in The American Journal of Sociology