"Special Needs"

 From the preface to The Politics of Autism.

A major theme of this book is that just about everything concerning autism is subject to argument. There is not even any consensus on what one should call people who have autism and other disabilities. “In the autism community, many self-advocates and their allies prefer terms such as `Autistic,’ `Autistic person,’ or `Autistic individual’ because we understand autism as an inherent part of an individual’s identity,” writes blogger Lydia Brown.[i] Other writers prefer “people-first” language (e.g., “persons with autism”) since it puts the persons ahead of the disability and describes what they have, not who they are.[ii] For the sake of stylistic variety, this book uses both kinds of language, even though this approach will satisfy neither side. I can only say that I mean no offense.

David Oliver at USA Today:

In our daily lives, we may encounter phrases like "I am disabled" or "My child has special needs." And to someone who is not part of the community, this wording may seem synonymous. But it's not.

Most experts and advocates vehemently oppose the term "special needs," and believe we need to eliminate it from our vernacular. Furthermore, they say avoiding the term "disabled" only leads to stigmatization.

For some, the term "special needs" feels offensive.

"I am disabled by society due to my impairment," says Lisette Torres-Gerald, board secretary for the National Coalition for Latinxs with Disabilities. "My needs are not 'special;' they are the same, human needs that everyone else has, and I should be able to fully participate in society just as much as the next person."

It can also be counterproductive.

Researchers from a 2016 study found people who are referred to as having "special needs" are seen more negatively than those referred to as having a disability.

...

The National Center on Disability and Journalism recommends never using it: "Our advice: avoid the term 'special needs.' Disabled is acceptable in most contexts, but we advise asking the person to whom you’re referring what they prefer."

Sonja Sharp, a metro reporter with the Los Angeles Times, prefers identity-first language: "disabled" over "person with disabilities." "It's cleaner, it's simpler, and it's more reflective of my reality," Sharp says. "The law defines me as disabled

Action Item from Regional Center

 In The Politics of Autism, I discuss services for people with disabilities.

Regional centers are private nonprofits that contract with Califorinia's Department of Developmental Services to coordinate or provide services for people with developmental disabilities. The 21 regional centers help disabled people and their families help find and access a variety of services.

Email rom the Frank D. Lanterman Regional Center:

TAKE ACTION - Call Governor Newsom's Office and Ask Him to Support the Regional Center Service Coordination Funding Request Help us support our California Legislature! We need Governor Newsom to support and strengthen services and supports for people with developmental disabilities. The California Legislature heard our voices and they reached a legislative agreement that our system needs: 921 service coordinators   Rate increases for our service providers   Lifting the suspension on non-medical therapies, social recreational services and camp

Please call Governor Newsom's office and say: "I would like the Governor to please support the regional center service coordination funding request and implementation of the Burns and Associates Rate Study, and lifting the suspension on low-cost high-value services."   How do you do this? It's easy! Call TODAY!   Call 916.445.2841   Dial 1 for English   Dial 6 to transfer to a representative   Dial 3 for option to leave a message, opinion or request.

Bogus Tests

In The Politics of Autism, I write:

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

Quacks usually recommend various kinds of tests and analyses.

From the American Academy of Pediatrics Council on Environmental Health:

Five Things Physicians and Patients Should Question

1 Do not routinely test urine for metals and minerals in children with autistic behaviors. Toxicologic exposures have not been conclusively associated with the development of autistic behaviors in children. Testing for metals and minerals may be harmful if treatment is guided on the basis of these results.

Thimerosol or ethylmercury has been used as a preservative in multidose vaccine vials and have been blamed for the increase in autism rates over the past 2 decades. However, studies have failed to show a causative link between environmental exposures and the development of these symptoms. As symptoms of autism occur early in childhood and, possibly, months to years after any potential exposure may have resulted in neurotoxicity, the likelihood of continued presence of such toxicant is low. Parents, however, may be desperate for answers and seek out alternative sources for information and receive advice to obtain laboratory analysis for minerals and metals as causative agents without insurance reimbursement. Finding an abnormal result has led to ill-advised treatments and death in some patients.

2 Do not order hair analyses for “environmental toxins” in children with behavioral or developmental disorders, including autism.

The analysis of hair for a broad array of elements and chemicals as a way to diagnose the cause of childhood diseases such as autistic spectrum disorder has no scientific basis. Such assays may not be reliable: hair collection is not precise and it is a heterogeneous matrix; chemicals in hair may not be distributed evenly from the root up the shaft, the assays used may not be accurate technically, and hair can easily be contaminated by external residues of dust, shampoos, conditioners, or other hair treatments. Reports of finding of various metals, etc, can create a severe anxiety in the families requiring further testing by other means. Historically, testing by standard means fail to verify the apparent exposure reported by hair analysis.

3 Do not order mold sensitivity testing on patients without clear allergy or asthma symptoms (particularly those with chronic fatigue, arthralgia, cognitive impairments, and affective disorders). For those with allergy or asthma symptoms who have not responded to environmental interventions to reduce allergen exposures, mold sensitivity testing may be performed by an allergist or pulmonologist, but should not routinely be performed in the primary care setting.

Mold can cause sensitization and clinical disease. Skin prick and in vitro tests can effectively identify patients who are sensitized to molds, although this does not always translate to clinical disease. Results of these tests must be interpreted in the context of the patient’s clinical presentation.

Exposure to dampness and mold can increase the risk of developing asthma in children regardless of their atopic status and increased symptoms of asthma and rhinitis in individuals who already have these conditions. Interventional studies have found that a multifaceted series of interventions aimed at reducing indoor moisture, removing contaminated building materials, and reducing reservoirs (including carpeting and dust) can reduce exposure sufficiently to reduce symptoms in affected individuals. This implies a causal relationship between exposure to fungi and morbidity and provides a rationale for environmental interventions to reduce it.

4 Do not order “chelation challenge” urinary analyses for children with suspected lead poisoning.

The “chelation challenge” was formerly used to assess whether a child had a significant body burden of lead, or “lead poisoning,” and whether formal chelation would result in significant clearance of lead. Evidence exists that suggests that the chelation challenge has no better prognostic value than the standard blood lead level. Further, there is some evidence that the chelation challenge may in fact be potentially dangerous. In summary, chelation challenge has no clinical utility in the treatment of childhood lead poisoning today

5 With the exception of certain heavy metals (eg, lead), do not routinely use measurements of environmental chemicals in a person’s blood or urine to make clinical decisions.

It is virtually impossible for people not to come into contact with hundreds of chemicals each day—whether those chemicals are in our food, air, water, soil, dust, or the products we use. And it is even more difficult for people to know whether those chemicals are harmful to their health or not. Presence does not mean toxicity.

The measurement of an environmental chemical in a person’s blood or urine does not by itself mean that the chemical causes disease. Advances in analytical methods allow us to measure low levels of environmental chemicals in people, but separate studies of varying exposure levels and health effects are needed to determine whether such blood or urine levels result in disease. These studies must also consider other factors such as duration of exposure. For some environmental chemicals, such as lead, research studies have given us a good understanding of the health risks associated with different blood lead levels. For many environmental chemicals (eg, phthalates, polychlorobiphenyls) more research is needed to assess health risks from different blood or urine levels. Thus, just because a chemical is found to be in the body does not mean that harm will occur. Moreover, these measurements are not helpful to guide clinical intervention or treatment. Pediatric Environmental Health Specialty Units (www.pehsu.org) can provide additional information about indications, measurement, and interpretation of environmental chemicals in blood or urine, including lead and other heavy metals.

Antivax Wackiness in Ohio

The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.   And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong. 

Testimony going off the rails now.

Tenpenny is claiming there is metal in the vaccine that causes forks to stick to your forehead. She saw videos of it on the internet, you see

Also promoting the 5G cell phone network vaccine theory. This is the anti-vaccine "expert witness" pic.twitter.com/sPpuAqmHba

— Tyler Buchanan (@Tylerjoelb) June 8, 2021

From PolitiFact:

Dr. Sherri Tenpenny is a licensed osteopathic physician and anti-vaccine advocate based in suburban Cleveland. Tenpenny is the author of “Saying No To Vaccines: A Resource Guide for All Ages” and has previously said vaccines cause autism, a claim public health officials have debunked.

Wow. An anti-vaccine nurse in Ohio tried to prove the Vaccines Cause Magnetism theory in an state legislative committee. The demonstration did not go to plan pic.twitter.com/0ubELst4E8

— Tyler Buchanan (@Tylerjoelb) June 9, 2021

"Medical Racism"

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.   And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong. 

 At Kaiser Health News, Will Strone reports on "Medical Racism."

The free online film is the latest effort by Robert F. Kennedy Jr., the founder of Children’s Health Defense. (He’s a son of former U.S. Attorney General Robert “Bobby” Kennedy and nephew of President John F. Kennedy.) With this film, Kennedy and his allies in the anti-vaccine movement resurface and promote disproven claims about the dangers of vaccines, while aiming squarely at a specific demographic: Black Americans.

The film draws a line from the real and disturbing history of racism and atrocities in the medical field — such as the Tuskegee syphilis study — to interviews with anti-vaccine activists who warn communities of color to be suspicious of modern-day vaccines.

At one point in “Medical Racism,” viewers are warned that “in Black communities something is very sinister” and “the same thing that happened in the 1930s during the eugenics movement” is happening again.

There is a lengthy discussion of the thoroughly disproven link between autism and vaccines. For example, the film references a study from the Centers for Disease Control and Prevention about the measles, mumps and rubella vaccine and autism rates as evidence that African American children are being particularly harmed, but in reality the study did not conclude that African Americans are at increased risk of autism because of vaccination.

The movie then displays a chart claiming to use that same CDC data — obtained through a Freedom of Information Act request — to make a connection between vaccinating Black children and autism risk. The findings in the chart closely resemble another study sometimes mentioned by anti-vaccine activists, but the medical journal later retracted the study, because of “undeclared competing interests on the part of the author” and “concerns about the validity of the methods and statistical analysis.” (That study’s author was a paid independent contractor for Kennedy’s group as of 2020 and sits on its board of directors.)

The film also brings up a 2014 study from the Mayo Clinic that showed Somali Americans and African Americans have a more robust immune response to the rubella vaccine than Caucasians and Hispanic Americans. One of those interviewed in Kennedy’s film then asks, “So if you have that process that could be caused by vaccines, why wouldn’t there be a link between vaccines and developmental delays?”

But the study’s author, leading vaccine researcher Dr. Gregory Poland, said this conjecture is not accurate.

According to a statement provided to NPR by the Mayo Clinic, the study demonstrated “higher protective immune responses in African-American subjects with no evidence of increased vaccine side effects,” and any claim of “‘increased vulnerability’ among African-Americans who receive the rubella vaccine is simply not supported by either this study or the science.”

Chokehold

In The Politics of Autism, I discuss interactions between police and autistic people.  Police officers need training to respond appropriately.  When they do not, things get out of hand.  Autistic people can suffer serious injury or death.

Tom Lally at WHAS-TV:

A 14-year-old boy was in a moment of crisis on Saturday. When he started threatening his mother Christina Brooking, her sister called the police to intervene. Brooking told WHAS11 News, "He had one of his moments, I guess his PTSD moments." She explained that her son Corey lives with autism, PTSD, and a physical disability. Graymoor-Devondale Police Chief Grady Throneberry said first responders have been called to Brooking's home 20 times during the past six months for similar issues. On three of those occasions, he said, officers had to fight or wrestle with Corey before he calmed down.

Two officers entered the apartment around 7:30 p.m. Saturday, to see Corey standing in the hallway with a broomstick. Corey called out for the officers to slide their guns and tasers to him, as he might have heard in his video games. Officers tried to help Corey calm down and his mother said she thought it was working. Then, she heard a struggle.

"The one cop was trying to put the cuffs on one of his arms and was kind of struggling," Brooking said. "And the other cop just put him in a chokehold."

She described her son's face turning blue and his eyes rolling back in his head.

Chief Throneberry described the move as a "lateral vascular restraint." Rather than restricting oxygen to the lungs, this chokehold restricts blood from the head. Both chokeholds are legal in Kentucky.

"The officers applied that correctly for less than ten seconds," Throneberry said. "I think they did exactly the right thing." 

New York Legislation on Employment

The Politics of Autism includes an extensive discussion of policy initiatives in the states.

At The Daily Gazette (Schenectady, New York), Asssemblyman Angelo Santabarbara writes that many autistic people face difficulty with employment.

To help alleviate this barrier, we need more than a culture of awareness. We need acceptance and incentives to get us there. The New York State Assembly recently passed a bill establishing a tax credit ranging from $5,000 to $25,000 for small businesses that employ people with disabilities (A.3960 of 2021).

This credit would be available for companies with fewer than 100 employees that employ a disabled person for at least six months for a minimum of 35 hours a week.

To further combat discriminatory employment practices, I have introduced a bill that would seek to award 5% of state contracts to businesses where 15% of the employees are individuals with disabilities (A.2593).

The bill would involve creating a statewide study to determine whether there is a disparity between the number of qualified businesses able to perform state contracts and the numbers actually engaged, and determine any changes needed.

Another bill passed would ensure the rights of state employees to sue New York state for damages due to violations of the Americans with Disabilities Act of 1990, the Fair Labor Standards Act of 1938 and the Family and Medical Leave Act of 1993 (A.7121).

This will not only give further agency to adults with disabilities, but will also deter employers from using discriminatory hiring and workplace practices.

In addition, this the legislative package included a measure aimed at promoting overall accessibility in the day-to-day lives of individuals with disabilities such as reestablishing the Office of the Advocate for People with Disabilities to help those with disabilities receive services and support in order to enable them to make informed choices and decisions (A.3130).

At 

YouTube, Conspiracy Theory, and Vaccine Hesitancy

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.   And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong. 

At Vaccines, Will Jennings and colleagues have an article titled  "Lack of Trust, Conspiracy Beliefs, and Social Media Use Predict COVID-19 Vaccine Hesitancy." The abstract:

As COVID-19 vaccines are rolled out across the world, there are growing concerns about the roles that trust, belief in conspiracy theories, and spread of misinformation through social media play in impacting vaccine hesitancy. We use a nationally representative survey of 1476 adults in the UK between 12 and 18 December 2020, along with 5 focus groups conducted during the same period. Trust is a core predictor, with distrust in vaccines in general and mistrust in government raising vaccine hesitancy. Trust in health institutions and experts and perceived personal threat are vital, with focus groups revealing that COVID-19 vaccine hesitancy is driven by a misunderstanding of herd immunity as providing protection, fear of rapid vaccine development and side effects, and beliefs that the virus is man-made and used for population control. In particular, those who obtain information from relatively unregulated social media sources—such as YouTube—that have recommendations tailored by watch history, and who hold general conspiratorial beliefs, are less willing to be vaccinated. Since an increasing number of individuals use social media for gathering health information, interventions require action from governments, health officials, and social media companies. More attention needs to be devoted to helping people understand their own risks, unpacking complex concepts, and filling knowledge voids.

From the article:

Our findings linking YouTube users to COVID-19 vaccine hesitancy are novel, but in line with existing research on other vaccines. A study of YouTube vaccine content found that 65.5% of videos discouraged vaccine use, focussing on autism, undisclosed risks, adverse reactions, and alleged mercury content [29]. A 2017 analysis of 560 YouTube vaccine videos in Italy found that the majority of videos were negative, linking vaccines with autism and serious side effects [30]. Those who refused vaccines in the focus groups had low levels of trust in the government, and believed that the virus was man-made or a type of population control for certain groups. Individuals who were younger and had lower levels of education were also vaccine-hesitant.

29. Basch, C.H.; Zybert, P.; Reeves, R.; Basch, C.E. What do popular YouTube videos say about vaccines? Child. Care. Health Dev. 2017, 43, 499–503. [Google Scholar] [CrossRef]
30. Donzelli, G.; Palomba, G.; Federigi, I.; Aquino, F.; Cioni, L.; Verani, M.; Carducci, A.; Lopalco, P. Misinformation on vaccination: A quantitative analysis of YouTube videos. Hum. Vaccin. Immunother. 2018, 14, 1654–1659. [Google Scholar] [CrossRef]

Autism and Food Insecurity

 In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their families. 

Arun Karpur and colleagues have an article at Autism titled "Food insecurity in the households of children with autism spectrum disorders and intellectual disabilities in the United States: Analysis of the National Survey of Children’s Health Data 2016–2018."  The lay abstract:

Families of children with autism spectrum disorder are more likely to experience financial strain and resulting food insecurity due to additional cost of care, disparate access to needed services, and loss of income resulting from parental job loss. Utilizing nationally representative data, this analysis indicates that the families of children with autism spectrum disorder and co-occurring intellectual disabilities are twice as likely to experience food insecurity than families of children without disabilities after adjusting for various factors. Several factors, ranging from state-level policies such as Medicaid expansion to individual-level factors such as higher utilization of emergency room services, were associated with the higher prevalence of food insecurity in families of children with autism spectrum disorder and co-occurring intellectual disabilities. Implications of these findings on programs and policies supporting families in the COVID-19 pandemic are discussed.

Budget Would Increase IDEA Funding

 In The Politics of Autism, I write about special education and the Individuals with Disabilities Education Act.  Full funding might happen.

From the FY2022 Budget:

To ensure that children with disabilities have the opportunity to thrive, the Budget includes $16 billion, a $2.7 billion increase from  the 2021 enacted level, for Individuals with Disabilities Education Act (IDEA) grants that would support special education and related services for more than 7.6 million preschool through grade 12 students. This is a significant first step toward fully funding IDEA. The Budget also provides $732 million for early intervention services for infants and toddlers with disabilities or delays, funding services that have a proven record of improving academic and developmental outcomes. The $250 million increase for early intervention services would be paired with reforms to expand access to these services for underserved children, including children of color and children from low-income families.

Senator Casey's Legislation on Policing and Disability

In The Politics of Autism, I discuss interactions between police and autistic people.  Police officers need training to respond appropriately.  When they do not -- as recent events have shown -- things get out of hand. 

Senator Bob Casey (D-PA) at The Hill:

According to the International Association of Chiefs of Police (IACP), police have become first responders for non-criminal complaints, such as people experiencing mental health crises. In addition, a recent report from the U.S. Department of Justice shows that compared with the general public, people with disabilities are more likely to be victims of violent crimes. When these interactions occur, they are more likely to turn violent. Data from the Ruderman Family Foundation found that people with disabilities made up between one-third and one-half of all individuals shot by law enforcement officers in 2015.

The demands on law enforcement are great. As the International Association of Chiefs of Police has said, when it comes to mental health crises, police have become the first responders. Many interactions between law enforcement and people with mental health and other disabilities such as autism, deafness, intellectual disabilities, have ended in serious injuries and deaths. The Washington Post reports that over 26 percent of police shootings since 2015 have involved people with mental health disabilities.

It is time to relieve law enforcement of the responsibility of responding to non-criminal emergencies and to reduce the interactions between police and people with disabilities. And, when necessary, we need to provide law enforcement officers with the skills necessary to have safe, effective interactions with people with disabilities.

That is why I have reintroduced two bills as part of my Law Enforcement Education and Accountability for People with Disabilities (LEAD) Initiative. One bill, the Human-services Emergency Program (HELP) Act, will divert non-criminal emergency calls away from 9-1-1 to agencies designed to address human service needs, such as the 2-1-1 system, and mental health needs, such as the National Suicide Prevention Lifeline, which will become the 9-8-8 three digit national call number in July 2022. The second bill, the Safe Interactions Act, will provide funding to train and educate new and veteran law enforcement officers about best practices to interact with and support people with disabilities. The training would be developed and implemented by people with disabilities who can speak from their lived experiences. A broad coalition of organizations has endorsed these bills, including ading national disability advocacy organizations such as the Autism Society of America, the Arc of the United States and the Bazelon Center for Mental Health Law. Support has also been secured by civil rights organizations such as the Center for American Progress and the Public Interest Law Center and national organizations representing law enforcement officers including the Fraternal Order of Police.

The Antivaxx Business

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.   And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong. 

The Center for Countering Digital Hate has a new report titled: Pandemic Profiteers: The Business of Anti-Vaxx.  The executive summary:

1. Analysis of the online anti-vaccine movement has identified a dozen leading antivaxxers who operate businesses or organisations with significant revenues.

2. These twelve are responsible for up to 70 percent of anti-vaccine content shared to Facebook. Three of these twelve - Joseph Mercola, Del Bigtree and Robert F. Kennedy Jr. - are so influential that they account for nearly half of this content.

3. Anti-vaxxers represent an industry with annual revenues of at least $36 million, based on a limited view of their finances based on self-reported filings and publicly available revenue estimates for 22 organisations belonging to twelve of the industry’s biggest earners. This anti-vaxx industry employs at least 266 people.

4. Anti-vaxxers have received more than $1.5 million in federal loans through the Paycheck Protection Program (PPP) designed to help businesses through the Covid pandemic. The largest such beneficiary was the anti-vaxx entrepreneur Joseph Mercola, whose business received $617,000 in total.

5. Some leading anti-vaxxers are earning six-figure salaries for leading roles at antivaccine non-profits, including Robert F. Kennedy Jr. who earns $255,000 a year as Chairman of Children’s Health Defense.

6. The anti-vaxx industry’s total social media following of 62 million could be worth up to $1.1 billion to social media platforms based on publicly available figures for the amount of revenue social media platforms make per impression or per user where that information is not available.

7. Leading anti-vaxxers are collaborating to market each other's disinformation and boost sales. Leading anti-vaxxers including Robert F. Kennedy Jr. took part in a popular affiliate marketing scheme established by anti-vaxx entrepreneurs Ty and Charlene Bollinger which claims to have paid out $14 million to partners who promoted their health disinformation.

8. Anti-vaxx organisations led by Robert F. Kennedy Jr., Del Bigtree and Larry Cook privately admit in legal filings that they are reliant on mainstream social media platforms for reach and revenue, saying that deplatforming has curtailed their ability to spread anti-vaccine messages.

9. The same legal filings reveal that platforms do not believe that deplatforming contravenes free speech protections, with Facebook and YouTube stating that they are “private parties, not state actors. And under settled law, their content-moderation decisions are not subject to First Amendment constraints.”

10. We recommend that social media platforms take action to stop anti-vaxxers profiting from undeclared paid promotions for products, something which is against both platform standards and advertising regulations in the US and UK.

11. For-profit anti-vaxxers who repeatedly breach platform standards on dangerous misinformation should be deplatformed. The evidence shows that deplatforming cuts the audience anti-vaxxers can access, as well as their revenues.

12. Platforms must keep their promises to stop profiting from vaccine disinformation. As long as they allow vaccine disinformation on their platforms, they continue to make ad revenues from anti-vaxxers and their followers.

COVID and Autism

 In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their families. Those challenges get far more intense during disasters.  And coronavirus is proving to be the biggest disaster of all. 

Arun Karpur, Vijay Vasudevan, Andy Shih & Thomas Frazier, "Brief Report: Impact of COVID-19 in Individuals with Autism Spectrum Disorders: Analysis of a National Private Claims Insurance Database," Journal of Autism and Developmental Disorders (2021), online first. Abstract

The COVID-19 pandemic continues to have a detrimental impact on individuals with disabilities. Data from FAIR Health’s FH® NPIC (National Private Insurance Claims) database, one of the nation’s largest databases of private insurance claim records, were analyzed to understand the experiences of individuals with ASD in the COVID-19 pandemic. Multivariate logistic regression models revealed that individuals with ASD + ID were nine times more likely to be hospitalized following COVID-19 infection (OR = 9.3; 95% CI: 6.9–12.5) and were nearly six times more likely to have an elevated length of hospital stay (OR = 5.9; 95% CI: 3.5–10.1) compared to those without ASD + ID. These findings point to the need for prioritizing access to vaccines to prevent COVID-19 infection and morbidities. This is the first study to illustrate a higher likelihood of hospitalization and elevated length of hospital stay from COVID-19 in individuals with ASD and other comorbidities.

From the article:

This is the first study to illustrate a higher likelihood of hospitalization and elevated length of hospital stay from COVID-19 infections for individuals with ASD and other comorbidities. While a lower proportion of individuals with ASD acquired COVID-19 infection than other condition groups, they were significantly more likely to be hospitalized for COVID-19 and have a longer length of stay in the hospital. Contrastingly, individuals with other chronic conditions had a higher prevalence of COVID-19 infections (e.g., Heart Failure, Obesity, Diabetes) had lower adjusted odds of hospitalization and elevated length of hospital stay. Underlying demographic patterns likely drive a lower overall prevalence of COVID-19 in ASD. A closer examination of the demographic distribution indicates that more than 90% of individuals with ASD were in the younger age range (i.e., less than 30 years old). Nearly 70% belonged to the 0–18-year-old group. As a result, most individuals with ASD in the data are likely living with their families during the pandemic, limiting their exposure compared to individuals in congregate living environments. A substantial increase in morbidity and mortality in COVID-19 among individuals with disabilities, especially among individuals with intellectual and developmental disabilities, has been associated with their living situation in congregate care settings (Landes et al., 2020).

Once individuals with ASD acquire COVID-19 infection, the regression models indicate a higher likelihood of hospitalization and elevated length of hospital stay. While Cunningham et al. (2020) described a similar pattern of lower COVID-19 prevalence and higher morbidity among young individuals using electronic medical records data, the quantitative differences in the likelihood of hospitalization and duration of stay for individuals with ASD is concerning and requires attention (Cunningham et al., 2020). Individuals with ASD, in general, have higher medical needs resulting from cooccurring mental health and other conditions such as epilepsy, digestive disorders, etc. (Karpur et al., 2018; Shea et al., 2018). It is possible that the COVID-19 infection, irrespective of severity, precipitates behavior health challenges leading to hospitalization and longer duration of stay (Bal et al., 2021; Righi et al., 2017; White et al., 2021). Further, several immunological theories, including the more recent preposition of abnormal melatonin production among individuals with ASD, might contribute to the increased severity of COVID-19 infection (Brown et al., 2021).

The findings of increased morbidity in COVID-19 are relevant from the perspective of growing discussion on the prioritization of populations for COVID-19 vaccines. Only a handful of states have considered prioritizing individuals with intellectual disabilities (see: https://www.kff.org/policy-watch/the-next-phase-of-vaccine-distribution-high-risk-medical-conditions/), and this does not include all individuals with ASD. However, given the challenges in consistently implementing social distancing practices and PPEs among individuals with ASD, it would be helpful to include them as one of the high-risk populations for immunizations.