CARD Opens Adult Center for Excellence

In The Politics of Autism, I discuss challenges and opportunities facing autistic adults.

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)centerforautism.com.

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 http://www.centerforautism.com

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.

Jennifer Chen, Ellen S Cohn, Gael Orsmond have an article at Autism titled "Parents’ Future Visions for their Autistic Transition-age Youth: Hopes and Expectations.  The abstract

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)

Nitric Oxide

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

• Pesticides;
• Air pollution and proximity to freeways;
• Maternal thyroid issues;
• Autoimmune disorders;
• Induced labor;
• Preterm birth;
• Fever  
• Birth by cesarean section;
• Maternal and paternal obesity;
• Maternal diabetes;
• Maternal and paternal age;
• Maternal post-traumatic stress disorder;
• Smoking during pregnancy;
• Antidepressant use during pregnancy;
• Polycystic ovary syndrome.
• Infant opioid withdrawal
• Zinc deficiency

Lief Pagalann and colleagues have an article at JAMA Pediatrics titled "Association of Prenatal Exposure to Air Pollution With Autism Spectrum Disorder." The abstract:

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.
Abstract

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.

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.

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.

The West and the Antivax Movement

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

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.

Keeping All Students Safe Act

In The Politics of Autism, I discuss 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

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.

House Committees

The Politics of Autism discusses legislation before Congress.

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.

Insurance Billing Codes

The Politics of Autism includes an extensive discussion of insurance.

From Autism Speaks:

New CPT codes for ABA billing have been announced by the American Medical Association CPT Editorial Panel. These codes will take effect on January 1, 2019.
Autism Speaks has worked for multiple years on the CPT Steering Committee seeking AMA approval of these new codes. We are happy to join the committee in helping you understand and implement the new CPT codes for ABA services.

What are CPT codes?

Current Procedural Terminology (CPT) is a listing of terms and identifying codes used to report medical services and to bill insurance providers. CPT codes are issued and maintained by the American Medical Association (AMA).

CPT codes are classified either as Category I (permanent) or Category III (temporary).

How have the CPT codes changed?

ABA codes were first approved in 2013 and fell under Category III (temporary).
A workgroup was formed shortly after in order to revise the code set. The CPT Steering Committee included Autism Speaks, the Association for Behavior Analysis International, the Association of Professional Behavior Analysts, and the Behavior Analyst Certification Board.

            In the fall of 2018, the new codes for ABA billing were announced with important changes:

Eight new Category I CPT (permanent) codes for ABA services were approved.
Two Category III (temporary) codes were revised.

Blythe Bernhard at Disability Scoop:

“We expect that it will expand the types of services that insurance companies reimburse for,” said Wayne Fisher, director of the Center for Autism Spectrum Disorders at the University of Nebraska Medical Center and a member of the steering committee made up of representatives from various autism organizations that worked on the coding changes.

With the move, the medical association will recognize ABA as medically necessary under appropriate circumstances, Fisher said.

Antivax Movement in New York and Oklahoma

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

Julia Belluz at Vox:

Anti-vaccine advocates have swayed parents in New York to refuse immunizations for their kids, sparking two of the largest measles outbreaks in the state’s recent history, according to local health officials.

As of Friday, 17 people in the neighborhoods of Williamsburg and Borough Park in New York City were confirmed with measles, along with 55 people in nearby Rockland County, for a total of 72 cases. Additional cases are currently under investigation, and the number is expected to rise.

What’s notable here is that all of the cases are occurring among unvaccinated or under-vaccinated Orthodox Jews, mainly children. When asked why people are opting out of vaccines, the city health department said anti-vaccine propagandists are distributing misinformation in the community.

The fearmongerers include the Brooklyn group called PEACH — or Parents Teaching and Advocating for Children’s Health — which spreads misinformation about vaccine safety, citing rabbis as authorities, through a hotline and magazines. Brooklyn Orthodox Rabbi William Handler has also been proclaiming the well-debunked link between the measles-mumps-rubella (MMR) vaccine and autism. Parents who “placate the gods of vaccination” are engaging in “child sacrifice,” he told Vox.

Last week, Republican Kevin Stitt won election as governor of Oklahoma.  In September, Sam Stein profiled him at The Daily Beast:

“I believe in choice,” Stitt said, “And we’ve got six children and we don’t vaccinate, we don’t do vaccinations on all of our children. So we definitely pick and choose which ones we’re gonna do. It’s gotta be up to the parents, we can never mandate that. I think there’s legislation right now that are trying to mandate that to go to public schools, it’s absolutely wrong. My wife was home schooled, I went to public schools, our kids go to Christian school, and that’s back to a parent’s choice.”

Stitt’s comments raise the specter that Oklahoma could water down immunization laws should he be elected the state’s governor this fall. They also place him within a growing fringe of politicians who have, in recent years, expressed skepticism over the prevalence of childhood vaccinations—a group that includes President Donald Trump himself.

“Kevin believes the topic of vaccinations is a serious decision that should be made by parents in consultation with their pediatricians,” said Donelle Harder, Stitt’s spokeswoman. She said that Stitt did not believe that vaccinations cause harmful medical side effects —an oft-argued and scientifically baseless claim from vaccine skeptics. The “root of his decision,” she said was the desire for parental choice

Such a position puts Stitt on the opposite side of public health advocates who have warned that immunizations must be a social contract in order to be medically effective. Anecdotal and scientific data has shown a direct correlation between vaccination hesitancy and the rise of diseases like measles.

Here is the video of Kevin Stitt speaking on the issues of vaccines.  When asked "So you would veto legislation that mandate [vaccines]" his response was "YEAH, THAT'S CORRECT" https://t.co/0kux558Jy5

— ILoveCatsMore (@ILoveCatsMore) September 9, 2018

TRICARE and ABA

In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their families.  As many posts have discussed, the challenges are especially great for military families.

Tom Philpott at Military Update:

Though TRICARE launched this ABA program in 2014, and has seen spending rise to $261 million annually, it’s still labeled a “demonstration” because the effectiveness of applied behavioral techniques for autism remains unproven, said Navy Capt. Edward Simmer, chief clinical officer of the TRICARE Health Plan.

“As of right now,” Simmer said, “Applied Behavioral Analysis does not meet TRICARE requirements for evidence-based coverage as part of the basic benefit. It still does not meet what we call the ‘hierarchy-of-evidence’ standard.”
...
First, ABA coverage coverage will continue through 2023 under a program extension approved earlier this year. Over that span TRICARE estimates that spending on ABA will rise to $430 million, the result of both medical inflation and a steady rise in number of children enrolled in the demonstration. Simmer estimates that only about half of all military children with autism currently receive ABA therapy.

A second notable development is that, at the direction of Congress, TRICARE is funding a $7 million research study, to run the length of the five-year extension. The purpose will be to learn how many ABA sessions are most effective.
...

Finally, Simmer said, TRICARE is broadening its autism program to encompass combinations of therapies, not solely ABA. The idea is to focus on “the whole child” while at the same time ensuring adequate support of parents whose involvement is seen as perhaps the most critical factor in effective therapy.

Signs of Hope in France

In The Politics of Autism, I describe the need for comparative perspectives on the issue.  France, where psychoanalysis long dominated -- and severely hampered -- autism treatment, is worth a special look.  There are some signs of hope there.

At The Journal of Autism and Developmental Disorders,  Carol Sankey, Cyrielle Derguy Céline Clément, Jennifer Ilg, and Émilie Cappe have an article titled "Supporting Parents of a Child with Autism Spectrum Disorder: The French Awakening."  The abstract:

After being wrongfully blamed for their child’s disturbances, French parents of a child with autism spectrum disorder (ASD) are now perceived as essential partners of care professionals. This shift in perspective has encouraged the development of parent training programs in the field of autism. In this paper, we present three programs currently implemented in France for parents of a child with ASD. We investigated their social validity, from the parents’ perspective. All three programs showed good social validity: attendance rate was good and parents were satisfied. In France, like elsewhere, more parents should be given the opportunity to participate in such programs to help them deal with the specific challenges of raising a child with ASD.