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Tuesday, March 15, 2022

President's Committee for People with Intellectual Disabilities

 In The Politics of Autism, I discuss the issue's role in presidential politics. 

Last week, President Biden announces his choices for the President’s Committee for People with Intellectual Disabilities. Several have connections to the autism community:

  • Nicole Jorwic is the Chief of Advocacy and Campaigns at Caring Across Generations. Before joining Caring Across, Jorwic was Senior Director of Public Policy and Senior Executive Officer of State Advocacy at The Arc of the United States. Before coming to DC to work on Federal Advocacy, she served as Senior Policy Advisor and Manager of the Employment First Initiative in Illinois. Prior to that appointment, Jorwic was the CEO/President of the Institute on Public Policy for People with Disabilities. She is also an accomplished special education attorney and an advocate for students with disabilities and their families. Jorwic is most importantly a sibling– her brother Chris is 32 and has autism.
  • Cathy Kanefsky’s personal experiences fuel her passion for serving mission-driven organizations. Kanefsky and her husband, Carl, have three sons. Thirty-year-old twins Sam and Adam were born four months early and live with significant physical and intellectual disabilities, including autism. Their 28-year-old son, Stephen, and his wife, Alexandra, are both special education teachers. After 14 years in leadership roles at the March of Dimes, Kanefsky built and led national field operations for Autism Speaks. Following five years as Chief Development Officer at A.I. duPont Hospital for Children, she now serves as the President and CEO of the Food Bank of Delaware. Her determination to help those seeking a better future is the foundation for enhancing job training and employment opportunities at the Food Bank – for all people – including those with intellectual disabilities.
  • M. Brent Leonhard is an Attorney in the Office of Legal Counsel for the Confederated Tribes of the Umatilla Indian Reservation. He has spent his career advocating for the advancement and expansion of the rights of tribal nations and citizens. In 2011, Leonhard was appointed to Attorney General Eric Holder’s Federal/Tribal Domestic Violence Taskforce. In 2015, he was appointed to the U.S. Sentencing Commission’s Tribal Issues Advisory Group. As a parent of an Autistic child, he is intimately familiar with the structural and systemic problems and frustrations those with intellectual or developmental disabilities face. Leonhard is intent on advocating for significant improvements to federal law and policy in this area.
  • Jordyn Zimmerman is a recent graduate from Boston College, where she earned her Masters of Education. Before graduate school, she interned at the National Disability Rights Network and completed her bachelor’s degree in Education Policy at Ohio University. As a nonspeaking autistic student who was denied access to effective augmentative communication until she was 18, Zimmerman has personal experience challenging the educational status quo, which is featured in the 2021 documentary, This Is Not About Me. Zimmerman also serves on the board of CommunicationFIRST and is passionate about ensuring every student is able to access effective communication and exercise their right to a truly inclusive education.

Monday, March 14, 2022

Waiting Lists and Shortages

The Politics of Autism includes an extensive discussion of insurance and  Medicaid services for adults with intellectual and developmental disabilitiesHome and Community-Based Services (HCBS) are particularly important.

The ANCOR Foundation and United Cerebral Palsy have published the Case for Inclusion 2022.  Some findings:

  • Nationally, the average DSP turnover rate in 2020 increased by about one percentage point to 43.6%. Meanwhile, vacancy rates for full-time direct support positions increased from 8.5% in 2019 to 12.3% in 2020—a roughly 45% increase. 
  • As of 2018, 16 states and the District of Columbia had closed their last remaining large, state-run institutions. Joining the ranks of states to have fully deinstitutionalized since last time the Case for Inclusion reported these data are Montana and Tennessee. 
  • 1 in 5 (21.1%) people with IDD who received employment or day supports were participating in an integrated employment service. Within the 33 states that report that they collect data on the number of people working, 19.3% of individuals participating in integrated employment services were working for pay. 
  • There were 589,940 people on states’ waiting lists for home- and community-based services nationally. Nearly 4 in 5 (78%) of those waiting were concentrated in just five states. Because this key findings report cannot cover every data point across all 80 measures contained in the Case for Inclusion’s seven main issue areas, we invite you to learn more and explore the data at caseforinclusion.org 
The report confirms that Texas is a hellhole for people with disabilities: 
  • "Strikingly, more than 78% of people on states’ waiting lists live in the five states with the largest waiting lists: Texas (323,434), Ohio (68,644), Louisiana (27,509), Florida (21,864) and Illinois (19,354)."
  • "States that had the largest number of PRFs in operation were Texas with 13, Ohio with eight and Illinois with seven. In terms of the number of people living in PRFs, Texas and Illinois had the dubious distinction of topping that list, with 2,969 and 1,664 residents, respectively, followed by New Jersey, with 1,325 people with IDD living in a PRF."

Sunday, March 13, 2022

Worldwide Prevalence

In The Politics of Autism, I discuss evaluationdiagnosis, and the uncertainty of prevalence estimates.

 At Autism Research, Jinan Zeidan,Eric Fombonne and colleagues have an article titled "Global prevalence of autism: A systematic review update." Lay abstract:

We reviewed studies of the prevalence of autism worldwide, considering the impact of geographic, ethnic, and socioeconomic factors on prevalence estimates. Approximately 1/100 children are diagnosed with autism spectrum disorder around the world. Prevalence estimates increased over time and varied greatly within and across sociodemographic groups. These findings reflect changes in the definition of autism and differences in the methodology and contexts of prevalence studies.

From the article:

In response to the need for an up-to-date global estimate of ASD prevalence, our review revealed a median prevalence of 65/10,000 as opposed to 62/10,000 in the previous review. In line with previous evidence, recent studies continue to report an increase in measured prevalence over time either at a country level and/or for specific subgroups, for example, the United States (Christensen et al., 2019; Jariwala-Parikh et al., 2019), South Korea (Hong et al., 2020), and Taiwan (Lai et al., 2012). Similarly, an increase in measured prevalence has been reported in later birth cohorts in France (van Bakel et al., 2015) and Australia (May et al., 2020; May et al., 2017; Randall et al., 2016).

Our findings also confirm that the substantial variability observed in the estimates can be, in part, accounted for by methodological and contextual differences among studies. First, surveillance systems, national registries, and other administrative databases offer larger and more representative samples relative to other study designs, but they are usually associated with lower sensitivity for case finding (Dodds et al., 2009), especially in areas with limited availability and/or access to service. In contrast, active case-finding procedures in cohort studies or population-based epidemiological surveys may result in more rigorous estimates, but their results are often confounded by multiple factors related to diverging strategies for case finding, evaluation, and confirmation used across studies. Second, methodological factors also interact with the broader community context where the level of awareness and capacity in health and education systems significantly impact autism identification, evaluation, and therefore prevalence estimates. Third, the evolving nature of the clinical definition of autism and its differentiation from overlapping conditions has continued to influence prevalence estimates.

 

Friday, March 11, 2022

Russia and Antivaxxers

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

Seventeen House members voted against Russia sanctions this week.  Most have encouraged vaccine skepticism or have ties to the antivax movement:

They are all bad, but on vaccines, Posey is the worst. Seven years ago, at Respectful Insolence, Orac took him:
I’ll also dispense with Posey’s denial that he is antivaccine, stated thusly, “To begin with, I am absolutely, resolutely pro-vaccine. Advancements in immunization have saved countless lives and have greatly benefited public health.” This is almost as risible as Robert F. Kennedy, Jr. characterizing himself as “fiercely pro-vaccine.” It’s nonsense. Posey is a man who has been on the side of the antivaccine fringe for quite some time. Heck, he even appeared at the antivaccine quackfest Autism One in 2013 as part of a “Congressional panel”! He even introduced legislation that’s gone nowhere requiring the CDC to do a retrospective “vaccinated vs. unvaccinated” study. As I put it, Posey appears to be vying to take over the title of most antivaccine legislator in the U.S. Congress since Dan Burton retired. Not surprisingly, he has received not-insubstantial donations from prominent members of the antivaccine movement, several with names that, if you typed them into the search box of this blog, would bring up multiple posts packed with pristine Insolence. Whenever someone who is a associated with the antivaccine movement and has demonstrated antivaccine proclivities through his actions so piously denies being antivaccine, a good rule of thumb is that he is almost certainly antivaccine, and in this case Posey is just that.

Thursday, March 10, 2022

Private Schools and IDEA


From the US Department of Education:
Part B of the Individuals with Disabilities Education Act (IDEA Part B) at Section 612(a)(10)(A) and its implementing regulations at 34 C.F.R. §§ 300.130 through 300.144 contain specific requirements regarding State and local responsibilities for equitable services for parentallyplaced private school children with disabilities.1 The U.S. Department of Education (Department), Office of Special Education and Rehabilitative Services (OSERS) issues this Questions and Answers (Q&A) document to provide State educational agencies (SEAs), local educational agencies (LEAs), parents, private school officials, advocacy organizations, and other interested parties with information regarding these requirements.2

...

As explained in this Q&A document, children with disabilities placed in private schools by their parents where FAPE is not at issue do not have an individual entitlement to the special education and related services they would receive if they were enrolled in a public school or placed in a private school by the LEA as a means of ensuring FAPE is made available.3 Depending on State law, private schools may not be required to meet State personnel or curriculum standards.4 Further, children with disabilities placed by their parents in private schools do not have the right to all of the protections under IDEA. For example, IDEA’s due process procedures do not apply to issues regarding the provision of services to any particular parentally-placed private school child with a disability. Parents of such children may only use IDEA’s due process procedures to resolve matters concerning an LEA’s obligation to meet the child find requirements.5 While IDEA provides no individual entitlement to children with disabilities whose parents have placed them in a private school when FAPE is not at issue, the law does require that an LEA spend a proportionate amount of its IDEA Part B funds to provide equitable services to this group of children, which could include direct and/or indirect services.6 In making these decisions, IDEA requires that the LEA engage in timely and meaningful consultation to determine which children with disabilities from this group will be designated to receive special education and related services.7 Therefore, it is possible that some of these parentally-placed private school children with disabilities will not receive any special education and related services.

Wednesday, March 9, 2022

Antivaxxers Amenable to Russian Propaganda


Kiera Butler at Mother Jones:
Since the beginning of the pandemic, we’ve seen how conspiracy theories can overlap and collide. I’ve documented how anti-vaccine groups embraced QAnon disinformation about liberal elites conspiring to unseat Trump, and how white nationalists find willing audiences for their racist ideology in anti-mask groups. Over the last week, a new disinformation hybrid has appeared, as online anti-vaccine groups have become a hotbed of pro-Russia conspiracy theories about the conflict in Ukraine—and some of the most prominent anti-vaccine activists are actively promoting geopolitical falsehoods.

Imran Ahmed, executive director of the online extremism tracking group Center for Countering Digital Hate, has been following the convergence of the conspiracy theories, and he’s noticed they share familiar themes: alleged secret government alliances, anti-Semitic accusations, and allusions to nefarious scientists. “There are particular individuals within the anti-vaccine world who are amenable to pro-Russian propaganda,” he says, “and that would include some of the people who’ve cohered around QAnon and Trump.”

One example of this is how an old Trump-era storyline—the theory that SARS-CoV-2 was deliberately engineered in a lab and released—seems to have been reconstituted in a new form: Anti-vaccine influencers claim that the United States owns a network of secret biolabs in Ukraine where dangerous infectious disease research takes place. For them, it’s just obvious that Biden is sending aid to Ukraine in order to protect those assets. This rumor has been proven to be manifestly false—but that hasn’t stopped it from circulating and gaining momentum.

Tuesday, March 8, 2022

Loneliness

In The Politics of Autism, I write:

Many analyses of autism speak as if it were only a childhood ailment and assume that parents are the main stakeholders. But most children with autism grow up to be adults with autism, and they suffer uniquely high levels of social isolation. Almost 40 percent of youth with an autism spectrum disorder never get together with friends, and 50 percent of never receive phone calls from friends. These figures are higher than for peers with intellectual disability, emotional disturbance, or learning disability. When school ends, many adults with autism have grim prospects. Though evidence is sparse, it seems that most do not find full-time jobs. Compared with other people their age, they have higher rates of depression, anxiety, bipolar disorder, and suicide attempts.

Kana Umagami and colleagues have an article at Autism titled "Loneliness in autistic adults: A systematic review."  Lay abstract:

Recently, researchers have been interested in how autistic people experience loneliness. Yet, most of this research has focused on loneliness in autistic children and young people. We present the results of a systematic review on loneliness in autistic adults. A systematic review is a rigorous way of searching for all existing research on a topic and summarizing the findings about specific questions. We searched for all research published on this topic until 9 April 2021. We found 34 articles that investigated loneliness in autistic adults. This research showed that (1) there is fairly little research that has involved directly asking autistic adults about their first-hand experiences of loneliness (e.g. what loneliness feels like for them); (2) few research studies have used loneliness questionnaires specifically developed for autistic adults (this was attempted in just one research study); (3) collective loneliness (i.e. loneliness associated with how much an autistic person feels they ‘fit in’ to society) seems important to autistic adults but has not been investigated as commonly as other aspects of loneliness (e.g. loneliness associated with romantic relationships or friendships); (4) things that might increase loneliness in autistic adults include anxiety and depression, and a lack of autism understanding and acceptance, for example; and (5) things that might reduce loneliness in autistic adults include having relationships and self-acceptance, for example. In our article, we discuss the kinds of future research on loneliness in autistic adults that might be useful.

Monday, March 7, 2022

Wakefield Time

As the 20th century wore on, meanwhile, many Americans began to have an increased respect for doctors and organized medicine, said James Colgrove, a professor of sociomedical sciences at Columbia and the author of ​​State of Immunity: The Politics of Vaccination in Twentieth-Century America.
...

Then, in 1998, British physician Andrew Wakefield published a study of 12 children that purported to suggest a link between the MMR (measles, mumps, and rubella) vaccine and autism. The study has been thoroughly discredited — Wakefield was found to have manipulated his data and lost his medical license, and subsequent research has found no link between vaccines and autism. But as Julia Belluz reported at Vox, media outlets covered the study with excessive enthusiasm and credulity, helping fan the flames of anti-vaccine sentiment.

The Wakefield paper also came out just as the internet was coming into wider use, Colgrove said. It was an unfortunate historical coincidence — a new piece of misinformation being released “at precisely the moment when this new medium for the spread of misinformation and conspiracy theories was really taking off.”

Wakefield’s discredited research and the media coverage and online conversation around it helped kick off the contemporary anti-vaccine movement. That movement grew throughout the 2000s thanks to a combination of factors, including a rise in anti-government sentiment and the emergence of a social media environment that tends to amplify conflict and controversy, Colgrove said.

Sunday, March 6, 2022

ABA in School

  In The Politics of Autism, I write:

As long as government funds so much research, politics will shape the questions that scientists ask and determine the kinds of research that receive funding.  Politics will even influence which scientists the policymakers will believe and which findings will guide public policy. In the end, science cannot tell us what kinds of outcomes we should want.  ABA “works” in the sense that it helps some autistic people become more like their typically developing peers.  Most parents regard such an outcome as desirable, but not all people on the spectrum agree.  

At Phi Delta Kappan Juliet E. Hart Barnett has an article titled "Serving students with autism: Ensuring a place for applied behavior analysis."

IDEA is clear in affirming the importance of parent-school collaboration in education programming for students with disabilities. And when it comes to meeting the needs of children and adolescents with ASD, the research shows that this collaboration should include not just parents and teachers but also ABA-trained therapists and healthcare providers. While therapists will be the ones to provide the ABA services, the research also suggests that teachers and other school staff should receive some basic training in this approach, so that they know how best to support their students.
But while we have strong evidence as to the benefits of applied behavioral analysis, researchers have not yet provided much guidance on the best ways to manage these partnerships, provide the necessary professional development, and deliver school-based ABA effectively and efficiently, perhaps lowering the cost of these interventions. Whether parents or school districts ultimately prevail in litigation over ABA services, cost concerns will likely remain front and center for school system leaders — not only because they might be forced to provide expensive services but also because the lawsuits themselves tend to be quite expensive (Decker & Hurwitz, 2018). All the more reason for researchers and policy makers to work together to find smart, evidence-based ways to deliver high-quality ABA-based services at a lower cost. All of us — students, parents, teachers, ABA providers, school and district leaders, and policy makers — share a vested interest in doing so.

 [Re-upping from 6/20/21Justin B. Leaf and colleagues have an article at The Journal of Autism and Developmental Disorders titled "Concerns About ABA-Based Intervention: An Evaluation and Recommendations."

 For over 50 years, intervention methods informed by the principles of applied behavior analysis (ABA) have been empirically researched and clinically implemented for autistics/individuals diagnosed with autism spectrum disorder (ASD). Despite the plethora of evidence for the effectiveness of ABA-based interventions, some autism rights and neurodiversity activists have expressed concerns with ABA-based interventions. Concerns have included discontent with historical events and possible harm from the procedures and goals targeted. The purpose of this manuscript is to examine some expressed concerns about ABA-based intervention and suggest productive ways of moving forward to provide the best outcomes for autistics/individuals diagnosed with ASD. The authors represent stakeholders from multiple sectors including board certified behavior analysts, licensed psychologists, parents, and autistics/individuals diagnosed with ASD.

Saturday, March 5, 2022

The 2022 Axis of Evil: Insurrectionists, Antivaxxers, and Russia


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

It should not be a surprise that they took part in the January 6 insurrection at the Capitol.


Zach Montague:
The founder of America’s Frontline Doctors, an activist group known for spreading misinformation and conspiracy theories about the pandemic and Covid vaccines, has pleaded guilty to a misdemeanor charge related to the storming of the U.S. Capitol on Jan. 6 last year.

According to a filing from the Justice Department, the doctor, Simone Gold, stood by as a Capitol Police officer was assaulted and dragged to the ground in front of her. She then entered the Capitol and delivered a speech in the National Statuary Hall denouncing vaccine mandates and lockdowns.

On Thursday, according to the filing, Dr. Gold pleaded guilty to one count of entering a restricted building, which carries a maximum sentence of one year in prison and a fine of $100,000.

Dr. Gold and America’s Frontline Doctors did not immediately respond to emails requesting comment.

Dr. Gold built a national following through America’s Frontline Doctors, which regularly peddles bogus pandemic claims, including promoting the antimalarial drug hydroxychloroquine as a Covid treatment in defiance of medical research and federal guidance. Videos circulated by the group during the pandemic spread rapidly online, boosted by conspiracy groups, often reaching millions of views before social media companies could take them down.

Friday, March 4, 2022

Private Equity Investment in Autism Services

 The Politics of Autism includes an extensive discussion of autism service providers.

The Private Equity Stakeholder Project has a report titled "The Kids Are Not Alright: How Private Equity Profits Off of Behavioral Health Services for Vulnerable and At-Risk Youth." 

 In the last several years private equity investment in autism services, particularly in providers of Applied Behavior Analysis (ABA) therapy, has substantially increased. While a handful of private equity investments in autism occurred earlier, 2017 and onwards have seen a flurry of private equity acquisitions.134 For example, in 2018 The Blackstone Group acquired the Center for Autism andRelated Disorders, with close to 2,000 employees, for a reported $700 million. It was reportedly the largest single autism provider deal in history.135 The year before, FFL Partners bought Autism Learning Partners (3,600 employees) for $270 million.136 In 2019 Gryphon Investors acquired LEARN Behavioral, (3,400 employees),137 and in July 2021 Cerberus Capital Management acquired Lighthouse Autism Center from Abry Partners for over $400 million.138

Because private equity investment in autism services is relatively new, little is known about what it means for quality of care. However, the profit-seeking tactics seen in private equity’s ownership of other behavioral health services, particularly in intellectual and developmental disability services, raises concern for how the business model will impact autism services.

 


Wednesday, March 2, 2022

Enforcement of Mental Health Parity Law

The Politics of Autism includes an extensive discussion of insurance and  Medicaid services for adults with intellectual and developmental disabilities.

In his State of the Union last night, President Biden said: "And let’s get all Americans the mental health services they need. More people they can turn to for help, and full parity between physical and mental health care. "

Katie O'Connor at Psychiatric News:
Federal agencies are using recently gained authority to crack down on health plans that are not complying with the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. A recent report to Congress outlines the enforcement work that has been done so far and illustrates the extent to which many plans are out of compliance, potentially cutting off thousands of people from the mental and substance use disorder treatments they need.

The report was issued by the departments of Labor (DOL), Health and Human Services (HHS), and Treasury as a requirement of the Consolidated Appropriations Act (CAA), which was enacted in December 2020 and included APA’s priority legislation, the Strengthening Behavioral Health Parity Act. The CAA amended MHPAEA to require health plans to perform and document comparative analyses of their non-quantitative treatment limits (NQTLs), which are the elements of a health plan’s coverage that are not numerical, such as prior authorization and formulary design.

NQTLs have, historically, been difficult to identify, and it is challenging for federal and state agencies to determine whether plans’ NQTLs comply with the parity law (Psychiatric News). The comparative analyses are vital for parity enforcement: Before the CAA, plans were not explicitly required to demonstrate and document that their NQTLs complied with the parity law, which was a major roadblock for enforcement.

...


The report includes several examples of enforcement leading to expanded access. EBSA discovered that a large service provider of self-funded plans was excluding applied behavior analysis (ABA) treatment for children with autism spectrum disorder. ABA “can improve the trajectory of a child’s development,” the report noted. After issuing requests for comparative analyses and initial findings of noncompliance to some of those plans, three health plans confirmed that they will now cover ABA therapy for autism, impacting over 18,000 plan participants. [See page 21 of the report.]

Tuesday, March 1, 2022

ASF Website

In The Politics of Autism, I discuss the many organizations engaged in advocacy and education.

From the Autism Science Foundation:
The Autism Science Foundation (ASF), a nonprofit organization dedicated to supporting families facing autism and to funding innovative autism research, has announced the debut of its comprehensive new website.

The modern new site is intended to serve as a trusted resource for families, individuals with autism, autism advocates, scientists, service providers, donors, members of the media and the general public.

Highlights of the new site include:

Evidence-based information about autism—what it is, early signs, what does (and does not) cause it and more.
“I am incredibly proud of our new website, which meaningfully furthers our mission to provide critical support to autism families and researchers,” said ASF Co-Founder and President Alison Singer. “Receiving an autism diagnosis for your child can feel overwhelming and scary, but the information on our new site equips parents with the evidence-based information they need to help their loved one thrive. The new site also continues to offer researchers the support they need to advance our understanding of autism and develop new treatments. We are so grateful to our generous donors for making this project possible.”

About the Autism Science Foundation

The Autism Science Foundation (ASF) is a 501(c) (3) public charity. Its mission is to support autism research by providing funding to scientists and organizations conducting autism research. ASF also provides information about autism to the general public and serves to increase awareness of autism spectrum disorders and the needs of individuals and families affected by autism. To learn more about the Autism Science Foundation or to make a donation, visit www.autismsciencefoundation.org.