Update from Dr. Pan

In The Politics of Autism, I discuss the discredited theory that vaccines cause autism.

In Pediatrics, Dr. Richard Pan, a California state senator, writes:

In California, AB2109, which reduced nonmedical exemptions for the first time in over a decade from 3.15% to 2.5% in 1 year, did not restore community immunity. The 2015 measles outbreak, beginning at Disneyland, spread across California and the country, reminding the public they were no longer safe from measles. Parents demanded action, and I authored SB277, abolishing nonmedical exemptions, which became law despite vociferous, well-funded opposition by antivaccine groups. In SB277’s first year of implementation, California’s kindergarten class achieved a vaccination rate of 96% through educational and public health efforts to increase public awareness and improve compliance with state vaccination laws.5 Further evaluation is needed to fully determine the success of SB277; however, numerous pediatricians have informed me that they now need to spend less time persuading families to vaccinate their children, but there are also reports of some physicians monetizing their license by selling medical exemptions.6

Thus, vaccination policy should not only address barriers to nonmedical exemptions but also address medical exemptions and the role of antivaccine groups in endangering public safety. Standards of care for granting medical exemptions must be clearly defined by the medical profession, and public health authorities should review medical exemptions to ensure these standards are met. Organizations that set professional standards (including certification boards, medical specialty societies, and licensing bodies) should sanction physicians who seek profit from unprofessional conduct that undermines public health and endangers children and communities. Antivaccine physicians tout these credentials to gain credibility with parents. In addition, policymakers need to establish consequences for people profiting from spreading misinformation that enables the spread of disease. Half of all Twitter posts about vaccines contain antivaccine beliefs.7 Just this year in Minnesota, antivaccine groups targeted a community, causing a significant drop in vaccination rates.8The resulting measles outbreak exposed >8000 people, sickened 79 (of which 73 were <10 22.="" a="" and="" hospitalized="" href="http://pediatrics.aappublications.org/content/141/1/e20173449#ref-9" old="" years="">9

Most importantly, pediatricians need to build the political will to pass effective vaccine policy. Antivaccine groups are organized and well funded, and they resort to intimidation and threats to suppress proscience advocacy on social media10 and in legislatures. To create the political will to pass SB277, we organized proscience parents to lead a broad coalition of not only physicians and public health advocates but also education, business, labor, and local government groups. Educating the public that vaccines are safe and effective is not enough. To protect our children and communities, child health advocates must organize proscience parents who care about public safety in their community to campaign for laws to restore community immunity. Vaccines work. Every child needs community immunity. For our children’s safety, we must fight back.

The Autism Paradox and the Dilemma of Difference

In The Politics of Autism, I write:

But what is equal treatment? This question raises the “dilemma of difference,” as legal scholar Martha Minow explains. “When does treating people differently emphasize their differences and stigmatize or hinder them on that basis? And when does treating people the same become insensitive to theirdifference and likely to stigmatize or hinder them on that basis?”[i]

---

[i] Martha Minow, Making All the Difference (Ithaca: Cornell University Press, 1990), 20.

At Aeon, Bonnie Evans writes: 

The diagnosis gained a foothold at the end of the 20th century not only because it ensured special educational services. It also slotted neatly into new models of social and economic liberalism in the 1980s and ’90s that aspired to dismantle systems of social welfare. Neoliberalism has arguably led to the ‘death of the social’, as the British sociologist Nikolas Rose noted in 1996, because it encouraged individuals to engage in a market for welfare products in order to boost their own advantage. In the case of autism, the diagnosis protected certain people from the mass demolition of social welfare systems in the 1980s.

It should be no surprise, then, that the most unwavering support for the autism diagnosis occurred under the UK prime minister Margaret Thatcher and the US president Ronald Reagan. It provided a kind of protection for citizens who were considered ‘impaired’ in their social function, and thus entitled to support in a way that others were not. In other words, autism as we know it today grew up as a kind of resistance to a neoliberal agenda, a tool for sheltering certain people from the growing challenges of global capitalism. And in the years since, it has become an important means of affirming identity.
...
Is there really an autism paradox? Or is this actually a paradox of human difference, and of what it means to delineate human types while also offering people the best opportunity to thrive. If we are to think creatively about how to identify difference without stigmatising it, it pays to think historically about how autism research got us to this point. Such history offers a rather humbling lesson: that it might very well be impossible to measure, classify and quantify an aspect of human psychology, without also muting attempts to tell the story differently.

Department of Education Finds Texas in Violation of IDEA

In The Politics of Autism, I discuss special education.  Some states do a reasonably good job, but Texas has not been one of them. A 2016 Houston Chronicle investigation revealed that tens of thousands of disabled students  were refused access to services because of a de-facto enrollment cap.

Christina Samuels at Education Week:

The U.S. Department of Education found that Texas violated the Individuals With Disabilities Education Act through a policy—recently rescinded—that subjected school districts to additional state scrutiny if their special education enrollment percentage went above 8.5 percent.

The office of special education programs on Thursday released a letter to state education chief Mike Morath as well as the results of a monitoring report. OSEP outlined several corrective actions the state must take, including:

• Finding and testing students who should have been referred for evaluation but were not;
• a plan to provide guidance to districts about their responsibilities under special education law; and,
• a plan for monitoring. OSEP said that it would work with the state, which is still recovering from Hurricane Harvey, on a mutually-agreeable timeline.

Defense Department Funds Research on Cannabis and Autism

In the Politics of Autism, I discuss funding of autism research:

Bureaucracies other than NIH came into play – even the Department of Defense. Starting with the 2007 defense appropriations bill, the Pentagon’s Office of the Congressionally Directed Medical Research Programs has included the Autism Research Program. Between fiscal years 2008 and 2012, NIH and ten other federal agencies awarded $1.2 billion to fund autism research projects.[i] In the meantime, private organizations such as the Simons Foundation and Autism Speaks also spent millions on autism science.[ii]

[i] U.S. Government Accountability Office, “Federal Autism Activities: Better Data and More Coordination Needed to Help Avoid the Potential for Unnecessary Duplication,” GAO 14-16, November 2013.  Online: http://www.gao.gov/assets/660/659147.pdf.[ii] U.S. Department of Health and Human Services, Interagency Autism Coordinating Committee, “2010 Autism Spectrum  Disorder Research Portfolio Analysis Report,” July 2012, p. 53. Online: https://iacc.hhs.gov/portfolio-analysis/2010/2010_portfolio_analysis.pdf.

A release from Montefiore Health System:

The Department of Defense (DOD) has awarded $1.3 million to fund a clinical trial at Montefiore Health System that will examine the effect of a cannabis compound called Cannabidivarin (CBDV) on irritability and repetitive behaviors in children with autism spectrum disorder (ASD). These characteristics are common in children with ASD and it is thought that the non-psychoactive and safe compound CBDV may be an effective way to address behaviors such as aggression, self-injurious behavior and tantrums.

One in 68 children has ASD. In addition to irritability and repetitive behaviors, such as rocking and hand-flapping, these children also have problems communicating. These symptoms are believed to be caused by underlying mechanisms in the brain. Since founding the Autism and Obsessive Compulsive Spectrum Program in 2009, Eric Hollander, M.D., director, Autism and Obsessive Compulsive Spectrum Program and Anxiety and Depression Program at Montefiore and Albert Einstein College of Medicine, and professor of psychiatry and behavioral sciences at Einstein, has conducted numerous clinical trials investigating the use of a variety of compounds and treatments to target these common, but challenging behaviors.

“The behavioral problems associated with ASD can cause significant burdens to children and their families,” said Dr. Hollander. “There are few medications available to treat ASD and current treatment options have substantial side effects. We are hoping that CBDV will prove to be an effective method for managing disruptive and impulsive behaviors in patients with ASD, while also targeting the mechanisms in the brain that cause the behaviors.”

The DOD spends millions of dollars on medical research every year through Congressionally Directed Medical Research Programs. The goal of the DOD is to support groundbreaking research that could help members of the military and their families. With so many children and families affected by ASD, the DOD recognizes the need for new and effective treatment methods. At Montefiore, the DOD grant will fund a phase two double-blind, randomized treatment trial where children with ASD aged five to 18 years old will receive either a CBDV pill or a placebo, twice daily over 12 weeks. Participants’ moods and behaviors will be measured on a standard behavioral checklist prior to and after the 12 week treatment to determine if CBDV improved both social and cognitive functioning, as it has been shown to do in animal models.

“The repetitive features of ASD are also common characteristics of a variety of other compulsive disorders, including Obsessive Compulsive Disorder and Body Dysmorphic Disorder,” said Dr. Hollander. “The overarching goal of our work is to discover new ways to target the underlying causes of all of these conditions, ease the associated symptoms and ultimately improve quality of life for many, many people.”

Dr. Hollander has dedicated his career to investigating the root causes of obsessive-compulsive and related disorders. He has more than 28 years of clinical and translational research experience, having been principal investigator on several federal grants and authored hundreds of research papers.

Oprah

In The Politics of Autism, I look at the discredited notion that vaccines cause autism.  Previous posts on this blog discussed Oprah Winfrey's role in spreading this idea.  Her well-received speech at the Golden Globes has sparked talk of a presidential run, which raises the issue of her antivax connection.

Megan Jula at Mother Jones:

Winfrey’s role in this controversy dates back to 2007, when she brought Jenny McCarthy, the Playboy model and actress, onto her show to talk about autism. McCarthy’s young son, Evan, had suffered a series of seizures at two-and-a-half years old and was later diagnosed with autism. McCarthy was adamant that the MMR vaccination Evan received as a baby caused his autism. On the show, McCarthy told Oprah she had been instinctually uncomfortable with allowing the doctor to give her son the vaccine. “I said to the doctor, I have a very bad feeling about this shot,” McCarthy recounted. “This is the autism shot, isn’t it?”

On the show, McCarthy’s claims went virtually unchallenged. Winfrey praised McCarthy as a “mother warrior” and plugged her book Louder Than Words: A Mother’s Journey in Healing Autism, which inaccurately suggests childhood vaccinations contribute to autism. Winfrey did read a brief statement from the Centers for Disease Control and Prevention, which said there was no scientific evidence of a connection and that scientists were continuing to study the causes of autism. “It is important to remember, vaccines protect and save lives. Vaccines protect infants, children and adults from the unnecessary harm and premature death caused by vaccine-preventable diseases,” the CDC statement concluded. But McCarthy had the final word. “My science is named Evan, and he’s at home,” she said. “That’s my science.

...
This wasn’t the first time Winfrey’s audience had been presented with the vaccines-autism theory. A few months before McCarthy’s appearance, Katie Wright, whose son has autism, said on the show, “The vaccine connection has not been refuted at all. In fact, we give 37 vaccines to babies under the age of 18 months. Nobody has shown that that’s safe, a wise idea, the multiple vaccines at once.”

“She wanted to say it, and I wanted you to get it out there,” Winfrey replied, as the audience clapped. “Because you are a mother dealing with your child every day.”

Prenatal Testing and Abortion

 In The Politics of Autism, I explain:

When a pregnancy is under way, doctors can detect certain kinds of disorders, but neither amniocentesis nor any other prenatal test can currently tell us whether a fetus will become autistic. Suppose that such a test did exist. “The best case use of a prenatal test at the moment would be if you could say to a parent, your child has got an 80 percent likelihood of autism and so once the baby's born, we would like to keep a close eye on that child in case they need extra support like speech therapy or social skills training or some sort of behavioral approach,” says leading autism scientist Simon Baron-Cohen. But would the “best case use” be the most common? When amniocentesis indicates Down Syndrome, most mothers choose abortion. A study of autism parents in Taiwan found that just over half would abort if a prenatal test indicated that their next child would be autistic. We cannot be sure what the figures would be if such tests were available in the United States, but it seems likely that a large share of autism pregnancies would end in abortion.

 In Burlington, NC, Elizabeth Pattman reports at The Times-News:

LabCorp has received a patent on a method for diagnosing autism spectrum disorders.

The method, invented by David Michael Margulies and Mark Firman Bear of Massachusetts, involves taking a tissue or body sample from a subject and then conducting a test to identify variant sequences in the subject’s genetic code, which may signify “the presence or an increased risk of developing autism spectrum disorders.” Testing can be done on children and fetuses, according to the patent.

The method is stated to aid in the diagnosis of five autism spectrum disorders, all of which fall under the umbrella of pervasive developmental disorders: autistic disorder, Asperger’s disorder, childhood disintegrative disorder, Rett’s disorder, and nonspecific pervasive developmental disorders.

Patent approved for gauging autism risk in fetuses. This makes me nervous. https://t.co/sBgazigZy4

— Steve Silberman (@stevesilberman) January 7, 2018

I tweeted about this yesterday, but to be very clear, this kind of testing (it's certainly not a "diagnosis") lays the groundwork for eugenics, and that's horrifying - and already going on with Down syndrome. https://t.co/sBgazigZy4

— Steve Silberman (@stevesilberman) January 8, 2018

Recordings and Rights in Conflict

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

Parents of an autistic Maine teen want him to have a recording device during the school day.  Alanna Durkin Richer reports at AP:

A novel case heading Monday to the 1st U.S. Circuit Court of Appeals in Boston, which hears most New England cases, pits the student's parents against his southern Maine school district, which says the recording device would infringe on other students' privacy rights. His parents say they need a glimpse into his day so they can better advocate for him at a school they don't trust isn't always telling the whole story.

"Most kids can come home and tell their parents what happened at school or what the teacher had done or not done. He can't do that," said Matthew Pollack, the father of the now 18-year-old Ben.
...
Attorneys for the district say teachers and administrators have gone above and beyond to provide the parents with information about the student, who they say loves school. A hearing officer concluded last year there is "simply no demonstrable benefit" to allowing the parents to record his day and that it would actually be "disruptive and detrimental" to his education.

In other states, parents of special education students have secretly placed audio recorders on their children to expose abuse, which have led to firings or settlements. And Texas recently began requiring school districts to install cameras in certain special education classrooms.

But opponents say such actions raise serious privacy concerns.

If parents can assert a right to "send an always-on listening device to school with their children, what would this mean for students who wished to report abuse or neglect at home to a school counselor, or for students with disabilities who are LGBT?" asked Samantha Crane of the Autistic Self Advocacy Network.

Organizing for the Alabama Mandate

The Politics of Autism includes an extensive discussion of insurance and the regulation of autism service providers.

At The Montgomery Advertiser, Brian Lyman has an oral history of the passage of Alabama mandate legislation.  This section deals with organizing:

Catey Hall, parent and advocate: A small group of parents and the Autism Society had done this for six years. What they did not have was a strong presence of advocates and parents self-advocating, asking legislators to support them. We decided we’re going to do that this year.

Lisa Whitson Riley, parent and advocate (son George was diagnosed with autism at age 4): The Autism Society sent out newsletters. I set up a Facebook page the first go-around that we all then started tapping into and using. We would use the Facebook page. We needed people who weren’t on the Facebook page. I posted everything. I did Facebook, Twitter and LinkedIn. And there was another parent who did Instagram and Snapchat. We flooded social media.

Hall: We would say ‘We need people here.’ And people came. It was hard for those families. The ones who couldn’t secure child care, they would bring their children with autism there.

Sen. Cam Ward, R-Alabaster: Catey was in the balcony videotaping the debates and streaming it live on Facebook. We didn’t have it on Facebook in 2012.

Bama Hager, policy and program director, Autism Society of Alabama: The grassroots support for the Alabama Autism Insurance Law was so tremendous that lawmakers soon became interested in learning more about the absence of insurance coverage for children who have autism. Parents, self-advocates living with autism, grandparents, aunts, uncles, teachers, neighbors and friends were advocating ferociously for this bill for their loved ones.

Derek Trotter, lobbyist: There were generally a couple of advocates in the State House on session days. We made sure they touched their members and their senator that represents them and whoever they could get in front of.

Riley: I had coffee parties. What I did was I posted on Facebook, ‘Hey, come meet me at the coffee house.’ We would pass out the list and call senators and members of the House and ask them to support this bill. We personalized it. Not just calling and saying ‘Support this because I want you to,’ but ‘I know someone.’

Wandering: One Sad Story

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

Beth Warren reports at the Louisville Courier Journal:

Shalom Lawson, an 8-year-old Louisville boy who loved hugging people he just met, wandered from a relative's home last summer and drowned.

He had autism, a disorder that causes many children to walk off. "Elopers,"as they are called, are especially drawn to water and are unaware of the risks.

"Water makes them feel calm, but water is very, very dangerous," said Shalom's mother, Magdalene Lawson, who came to America from West Africa with her husband, Charles.

She told Courier Journal she tried to protect her son by locking her bathroom to keep him from filling up the bathtub. She feared he would burn himself or drown. And she said she kept an alarm on her front door that would beep if he tried to get out.

But on a visit with family near Indianapolis last July, Shalom wandered off and drowned in a retention pond.

The story of Shalom's death is being shared with MetroSafe dispatchers and others who respond to emergencies in the Louisville area by trainers who are working with them on how to help people with autism.

"The police, fire department and EMS are in our society to be that resource to every individual," said Deborah Morton, executive director of Families for Effective Autism Treatment in Louisville. She said a tense situation can turn chaotic if emergency personnel don't know how to respond.

More on Sessions Decision to Rescind ADA Guidance

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

David M. Perry at Pacific Standard:

On the Thursday afternoon before the Christmas holidays, Attorney General Jeff Sessions' Department of Justice rescinded 25 guidance documents that the department found "unnecessary, inconsistent with existing law, or otherwise improper." The list included 10 texts on disability rights, including one as recent as 2016 (i.e. hardly out of date). This recent document codified the labor rights of disabled people as they move from sheltered workshops paying sub-minimum wage into the integrated economy. Its deletion represents the latest effort of the Trump administration to roll back disability protections in the 21st century.

...
I spoke over the phone to Eve Hill, former deputy assistant attorney general for the DOJ's Civil Rights Division. Hill tells me that technical assistance around the ADA is vital for everyone involved. Removing it doesn't change the law; "the law is the law," she says. But when people don't understand that law, access to services can be threatened, and the courts become the only recourse. Hill says she's angry because the Trump administration is taking away a proactive and "helpful approach," leaving confusion (and the likelihood of litigation) in its wake. 

A Decermber 26 statement from the Consortium for Citizens with Disabilities:

On December 21, the U.S. Department of Justice rescinded its Statement on Application of the Integration Mandate of Title II of the Americans with Disabilities Act and Olmstead v. L.C. to State and local Governments' Employment Service Systems for Individuals with Disabilities. The statement, which was issued last year, described the obligations of states to administer their employment services for people with disabilities in the most integrated setting appropriate. Evidence-based supported employment services help people with disabilities secure and maintain competitive, integrated employment. They are critical to achieving the ADA's goals of independent living and economic self-sufficiency.

We are extremely concerned about the withdrawal of this guidance document, both because it sends the wrong signal to public entities that are seeking to comply with the ADA and because it may reflect a diminished concern with the importance of providing employment services in the most integrated setting. As the Justice Department notes, withdrawal of this guidance "does not change the legal responsibilities of State and local governments under title II of the ADA, as reflected in the ADA, its implementing regulations, and other binding legal requirements and judicial precedent, including the U.S. Supreme Court’s Olmstead decision." The Statement reflected already established law, and its withdrawal does nothing to change that law, existing settlement agreements, or prior Justice Department findings letters about the application of the ADA's integration mandate and Olmstead to employment systems.

The vast majority of people with disabilities and their families want opportunities for competitive integrated employment. Most employment service providers, in response to best practices, federal law, and DOJ Guidance, are working to change their business models away from sheltered work to competitive integrated employment, and almost all states have embraced an "employment first" approach reflecting that shift. The Department's guidance was consistent with the priority the disability community has placed on enforcement of their civil rights to work alongside and with the same conditions as their peers without disabilities.

We are committed to expanding opportunities for all people with disabilities to have opportunities to work alongside their non-disabled peers for competitive wages and fulfill the ADA’s goals of integration, independence and economic self-sufficiency. We urge the Justice Department to remain committed to these goals as well.

We are also concerned about the process by which the Department announced that it is withdrawing nine other technical assistance documents on the same day. While some of these documents were outdated, government transparency is critically important. We were concerned to see so many documents suddenly withdrawn with little explanation of the reasons for doing so. Guidance documents are important tools to educate all stakeholders about the requirements of the law in a clear fashion, and the withdrawal of some of these guidance documents may create confusion and misunderstanding.

The Exemption Industry

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

Previous posts described efforts to get around vaccine requirements through medical exemptions.  Joanna Nix reports at Mother Jones:

Fueling this spike in medical exemptions is an industry of doctors willing—and sometimes eager—to flout the recommendations of the Centers for Disease Control and Prevention in the name of “parent choice.” Led by Orange County pediatrician Bob Sears, author of the influential The Vaccine Book and son of pediatrician and attachment parenting guru Bill Sears, many physicians are wary of the CDC’s vaccination schedule, believing that giving kids too many vaccines at once may be dangerous. (In 2013, the Institute of Medicine found no evidence that the schedule was unsafe.) The doctors are supported by a movement of anti-vaccine parents, many of whom believe the MMR vaccine causes autism. That view is rooted in a 1998 paper that was later retracted by The Lancet and declared “an elaborate fraud” by the British Medical Journal.

But the damage has been done. In 2015, soon after SB 277 was passed, a California-based nonprofit popped up called Physicians for Informed Consent (PIC). A coalition of about 200 doctors, scientists, and attorneys who vehemently oppose mandatory vaccine laws, it boasts Sears as a founding member.

Has Prevalence Reached a Plateau?

In The Politics of Autism, I discuss prevalence and talk of an "autism epidemic."

Guifeng Xu and colleagues have a JAMA research letter titled "Prevalence of Autism Spectrum Disorder Among US Children and Adolescents, 2014-2016."   A summary in Medical Express:

.After more than a decade of steady increases in the rate of children diagnosed with autism in the United States, the rate has plateaued in the past three years, researchers said Tuesday.

The findings were based on a nationwide study in which more than 30,000 parents reported whether or not their children had been diagnosed with autism spectrum disorder (ASD).

"The estimated ASD prevalence was 2.41 percent among US children and adolescents in 2014-2016, with no statistically significant increase over the three years," said the research letter by experts at the University of Iowa, published in the Journal of the American Medical Association (JAMA).

The first observation of a plateau was made by a separate group in 2012, when the rate flattened out to 1.46 percent, according to the Autism and Developmental Disabilities Monitoring (ADDM) Network.

Federal health authorities say that means about one in 68 children in the United States have the neurodevelopmental disability, whose causes remain poorly understood.

The ADDM had documented a "continuous increase from 0.67 percent in 2000 to 1.47 percent in 2010."

The 2.4 percent rate described in the JAMA report translate to one in 47 children, but researchers cautioned that the discrepancy may be explained by "differences in study design and participant characteristics."
The JAMA report, based on the annual National Health Interview Survey, did not delve into "underlying causes for the findings and cannot make conclusions about their medical significance."

The US Centers for Disease Control and Prevention also noted a plateau in the autism rate in 2016, but said it was "too soon to know whether ASD prevalence in the United States might be starting to stabilize."

What Works for Autistic College Students

 In The Politics of Autism, I discuss the growing number of college students on the spectrum:

We do know that autistic students suffer high levels of depression, anxiety, and social isolation. We also know that their difficulties can affect their academic performance. (Group projects can be hard.) They have to cope with these problems without the protection of an IEP, since the Individuals with Disabilities Education Act does not apply to higher education. The Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act of 1973 provide for certain accommodations (for instance, extra time for tests), but the student has to seek them. According to Jane Brown Thierfeld, co-director of an organization of professionals who assist autistic students, for every student receiving special services, there are one or two on that same campus who have not come forward.

At The Journal of Autism and Developmental Disorders, S. Jay Kuder and Amy Accardo have an article titled "What Works for College Students with Autism Spectrum Disorder."  The abstract:

This article reports the results of a systematic review of the emerging research on programs and services designed to meet the needs of students with ASD. For the purposes of this review, only articles that included data on program outcomes were included. A total of eight studies that met this criterion were identified. These studies included three that examined the effects of cognitive-behavioral interventions, three that reported the results of methods to enhance social communication skills, one study of a transition to college program, and one evaluation of a variety of widely used accommodations. This review identifies methods that have been found to be effective supporting students with ASD in higher education settings as well as needs for future research.

From the article:

The findings of our review indicate that, while there is a growing research base on effective methods for meeting the challenges of college students with ASD, the results of the research thus far have been mixed and, in some cases, based on limited data.

... 

 Despite the limitations described previously, there are some very promising practices. ... Jansen et al. (2017) identified several practices that students found to be effective. Although the researchers did not verify student perceptions with other data that would indicate whether methods such as extended time to complete exams and taking exams in smaller groups actually resulted in improved student outcomes, these methods can be considered promising practices. Although the study by White et al. (2016) failed to find a clear pattern of success for the two psychosocial training methods they investigated, the student responses suggest that a combination of the use of technology with a personalized, individualized psychosocial support program may be optimal for enhancing the overall functioning of college students with ASD. Likewise, the program described by Weiss and Rohland (2015) appears to have the potential to improve both social communication and executive functioning skills and lead to improved student retention if replicated in other university settings.

• Jansen, D., Petry, K., Ceulemans, E., Noens, I., & Baeyens, D. (2017). Functioning and participation problems of students with ASD in higher education: Which reasonable accommodations are effective? European Journal of Special Needs Education, 32(1), 71–88. https://doi.org/10.1080/08856257.2016.1254962.CrossRefGoogle Scholar
• Weiss, A., & Rohland, P. (2015). Implementing a communication coaching program for students with ASD spectrum disorders in postsecondary education. Topics in Language Disorders, 35(4), 345–361. https://doi.org/10.1097/TLD.0000000000000071.CrossRefGoogle Scholar
• White, S., Richey, J., Gracanin, D., Coffman, M., Elias, R., LaConte, S., & Ollendick, T. (2016). Psychosocial and computer-assisted intervention for college students with ASD spectrum disorder: Preliminary support for feasibility. Education and Training in Autism and Developmental Disabilities, 51(3), 307–317. https://doi.org/10.1542/peds.2011-1601.PubMedPubMedCentralGoogle Scholar