Study: Kids from Poor Neighborhoods Are Less Likely to Get an Autism Diagnosis

In The Politics of Autism, I write about the experiences of different economic, ethnic and racial groups.   Inequality is a big part of the story. Affluent school districts have more resources than poor ones.  Educated professionals are better able to protect their children's interests than poor people who never went to college.

A release from the University of Wisconsin-Madison

Children living in neighborhoods where incomes are low and fewer adults have bachelor's degrees are less likely to be diagnosed with autism spectrum disorder compared to kids from more affluent neighborhoods.

The finding is part of a new multi-institution study of autism spectrum disorder(ASD), led by Maureen Durkin of the University of Wisconsin-Madison's Waisman Center, and published recently in the American Journal of Public Health.

Durkin and her team found that the incidence of the disorder increased during the study period. In fact, during the eight years of the study, the overall prevalence of ASD in children more than doubled, increasing from 6.6 to 14.7 cases per thousand children.

"We wanted to see if part of this increase in ASD prevalence was because advances in screening techniques and medical training meant more children from disadvantaged backgrounds were gaining access to ASD diagnoses and services," says Durkin, a professor of population health sciences and pediatrics at UW-Madison. "It doesn't seem that's the case."

Her team analyzed education and health care data for 1.3 million 8-year-old children from a Centers for Disease Control and Prevention population-based surveillance program, with sites in 11 states across the U.S.: Alabama, Arizona, Arkansas, Colorado, Georgia, Maryland, Missouri, New Jersey, North Carolina, Utah and Wisconsin.

The study merged this autism surveillance data with U.S. Census measures of socioeconomic status, such as number of adults who have bachelor's degrees, poverty and median household incomes in the census tracts studied.

It found that regardless of which indicator of socioeconomic status the researchers used, children living in census tracts with lower socioeconomic development were less likely to be diagnosed with ASD than children living in areas with higher socioeconomic indicators.

While not the first study to highlight socioeconomic differences in rates of autism diagnosis, "the continued increase in prevalence of ASD makes understanding its epidemiology critical to ensure services are reaching the children who need them the most," says Durkin.The study does not prove children from lower socioeconomic backgrounds are not getting the diagnoses and support they need, Durkin says, but it does indicate that's the most likely scenario.

In support of this hypothesis, the study found that children who had intellectual disabilities were equally likely to be diagnosed with ASD irrespective of their socioeconomic backgrounds.

That could be because "children with intellectual disabilities usually have developmental delays that get noticed earlier in life," says Durkin. "They may get referred for comprehensive medical follow-ups, which could then lead to a diagnosis of their ASD as well."

In addition, studies in Sweden and France—which have universal health care and fewer barriers for citizens to access medical care—found no association between socioeconomic status and rates of autism diagnoses.

These findings collectively support the idea that children living in poorer or less well-educated areas are being diagnosed with ASD at lower rates because they have less access to health care providers who could make the diagnosis and provide needed support.

Effects of Insurance Mandates

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

Colleen L. Barry, Andrew J. Epstein, Steven C. Marcus, Alene Kennedy-Hendricks, Molly K. Candon, Ming Xie, and David S. Mandell have an article at Health Affairs titled "Effects Of State Insurance Mandates On Health Care Use And Spending For Autism Spectrum Disorder."

The abstract:

Forty-six states and the District of Columbia have enacted insurance mandates that require commercial insurers to cover treatment for children with autism spectrum disorder (ASD). This study examined whether implementing autism mandates altered service use or spending among commercially insured children with ASD. We compared children age twenty-one or younger who were eligible for mandates to children not subject to mandates using 2008–12 claims data from three national insurers. Increases in service use and spending attributable to state mandates were detected for all outcomes. Mandates were associated with a 3.4-percentage-point increase in monthly use and a $77 increase in monthly spending on ASD-specific services. Effects were larger for younger children and increased with the number of years since mandate implementation. These increases suggest that state mandates are an effective tool for broadening access to autism treatment under commercial insurance.

From a release by the Johns Hopkins University Bloomberg School of Public Health:

"The hope of patient advocates and policymakers was that these insurer mandates would increase care for children with autism, and they seem to have done that—in fact, the impact was even larger than we had expected," says Colleen L. Barry, PhD, MPP, the Fred and Julie Soper Professor and Chair of the Department of Health Policy and Management at the Bloomberg School.

The results, Barry adds, are important for states that have enacted such mandates to understand their impact, and also helpful for states considering whether to broaden mandates that are already in place. Barry is also affiliated faculty with the Johns Hopkins Wendy Klag Center for Autism and Developmental Disabilities at the Bloomberg School.

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Recent federal laws including the Affordable Care Act have introduced nationwide coverage mandates, including "parity" mandates requiring that coverage of mental health care be equal to coverage of general health care. But how closely these regulations apply to behavioral therapies for ASDs is still being debated—even litigated—among insurers and patient advocacy groups.

"Concern that children with autism were not able to access services through private insurance even in the context of parity laws was one reason why patient advocates have pushed for these state mandates that apply specifically to autism coverage," Barry says.

California Governor Signs Bill to Make ABA More Available

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

A release from the Center for Autism and Releated Disorders:

California Governor Jerry Brown has signed Assembly Bill 1074, a bill authored by Assembly Member Brian Maienschein (R- San Diego) and co-sponsored by California Association for Behavior Analysis (CalABA) and the Center for Autism and Related Disorders (CARD). The bill received overwhelming support from both the California Assembly and Senate.

AB 1074 makes critical updates to California’s autism mandate, already regarded as one of the strongest in the nation. In addition to technical changes, AB 1074 removes the requirement for autism treatment professionals to be vendored with a state regional center and clarifies that evidence-based autism treatment includes clinical case management. Additionally, the bill removes a 6-month experience requirement for paraprofessionals who work one-to-one with individuals affected by autism spectrum disorder (ASD), a requirement that has limited the capacity of California’s autism treatment providers to meet the needs of California’s autism community.

“I’m gratified to have had the opportunity to increase access to treatment for individuals affected by autism. This bill clarifies California’s autism mandate to ensure behavioral health providers are not hindered by outdated requirements,” said Assembly Member Maienschein.

The bill’s co-sponsors worked together with Assembly Member Maienschein to identify how to increase access to evidence-based autism treatment without jeopardizing treatment quality or consumer safety.

“We are so thankful for Assembly Member Maienschein’s dedication to California’s autism community. AB 1074 ensures that individuals affected by autism have access to medically necessary treatment and that providers can increase their capacity to provide services without diluting treatment quality,” said Doreen Granpeesheh, Ph.D., BCBA-D, executive director and founder of CARD.

California is home to more autism treatment providers than any other state; yet, individuals diagnosed with ASD often encounter delays and waiting lists when seeking medically necessary treatment.

About California Association for Behavior Analysis (CalABA)
California Association for Behavior Analysis (CalABA) is the professional membership association representing behavior analysts in California. CalABA is dedicated to advancing, promoting, and protecting the science and practice of behavior analysis. For more information, visit http://www.calaba.org. 

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 clinical 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. For more information, visit http://www.centerforautism.com or call (855) 345-2273.

Language Barriers and Autism Services

In The Politics of Autism, I discuss the relationships of autism, class, race, and ethnicity.

Helaine G. St. Amant and colleagues have an article at the Journal of Autism and Developmental Disorders titled "Language Barriers Impact Access to Services for Children with Autism Spectrum Disorders."

The abstract:

Racial and ethnic disparities in accessing health care have been described in children with autism spectrum disorder (ASD). In a retrospective chart review of 152 children with ASD, children of parents whose primary language was English were significantly more likely to have both social skills and communication goals within their individualized education plan (IEP) compared to children of parents whose primary language was not English. Additionally, children of primary English speakers received significantly more hours of direct services from their state disability program. After controlling for demographic covariates, findings suggest that language barriers may negatively affect parents’ abilities to access health care services for their child with ASD. Acculturation factors must therefore be considered when analyzing disparities in autism.

From the article:

Study results show that children whose parents spoke English as a primary language received significantly more hours of services provided by CA DDS Regional Centers than children whose parents primarily spoke a language other than English. These results are supported by previous studies showing a link between English–Spanish language barriers and reduced access to ASD-specific health care services (Liptak et al. 2008; Mandell et al. 2009) and are particularly meaningful as 53% of parents in our sample spoke Spanish as a primary language and only 34% spoke English as a primary language. It is of note that while primary language is major component and indicator of acculturation (Schumann 1986) acculturation is multi-dimensional by nature and not all components of acculturation were accounted for by this study.

Additionally, significant differences in IEP goal content were found by this study. Analyses showed that children of parents whose primary language was English were significantly more likely to have both social skills goals and communication skills goals listed in their IEP. The maintenance and continued evaluation of IEPs is dependent in large part on parent involvement [e.g. according to Disability Rights California, neither federal nor state law limits the number of IEPs a parent can request per year; parents may request initial special education service assessments (California Education Code 2001) and parents are encouraged to contribute to IEP meetings by reporting on their child’s academic, developmental and functional needs, the strengths of their child and concerns regarding education enhancement opportunities (California Education Code 2010)]. The discrepancy in the quality of IEPs found by this study may represent differences in the variable profile of ASD across primary language, but may also reflect the heightened challenge faced by parents whose primary language is not English to advocate for specific, appropriate IEP content. It is possible that the language barrier between parents whose primary language is not English and CA public school administrators and teachers plays a role in rendering the content of these IEPs less specific to the needs of a child with ASD, considering previous publications citing challenges associated with language barriers in IEP meetings (Cheatham 2010; Lian and Fontánez-Phelan 2001; Salas 2004)

Variation in Special Education

In The Politics of Autism, I write:

A child’s chances of getting an autism label vary by geography as well as social class. On a broad level, state definitions of autism are consistent with the federal definition. At the practical level, there are differences, especially when it comes to assessing social and emotional development, health, vision, hearing, and motor skills. In 2011, seven percent of students receiving IDEA services nationwide had an autism determination. But the figures varied by state. The states with the highest share of IDEA students with identified autism were Minnesota (12.8 percent), Oregon (10.6 percent), and Connecticut (10.1 percent). The lowest were Iowa (1.1 percent), Puerto Rico (2.1 percent), Montana (2.8 percent), Oklahoma and West Virginia (3.7 percent each).  

Christiana Samuels at Education Week:

Despite wide variation in the percentage of students enrolled in special education, a majority of teachers, principals and special administrators in a given state feel that the classification rates are largely on target, says a new report from Frontline Learning and Research Institute.

More than 17 percent of the students who live in Maine, Massachusetts, New York, and Pennsylvania are enrolled in special education, far outstripping the classification rates in other states, according to federal data. In contrast, Colorado, Hawaii, Idaho, and Texas—the four states with the lowest percentage of students in special education—have classification rates around 10 percent or less.

Most educators and principals feel these numbers are correct, even though they deviate from the national average of special education enrollment, 12 percent.

The insititute is a division of Frontline Education, which provides administrative and human resources software products to educational organizations nationwide. The institute draws on data from more than 12,000 school districts and millions of users of its products to create data-driven research on educational topics. This report, "Crossing the Line: Exploring Equity in Special Education Classification Across the United States," is one of four reports planned on special education topics.

Bipartisan House Working Group on Employing People with Disabilities

In The Politics of Autism, I discuss the employment of adults with autism and other developmental disabilities. Many posts have discussed programs to provide them with training and experience. 

An October 3 statement from Cathy McMorris Rodgers:

House Republican Conference Chair Cathy McMorris Rodgers (R-WA) announced a new bipartisan Congressional working group focused on employing people with disabilities. The announcement took place at a press conference hosted by the National Down Syndrome Society (NDSS). The title of the working group is the “Bipartisan House Working Group on Employing People with Disabilities.” Its five members are: House GOP Chair Cathy McMorris Rodgers (R-WA), House Democrat Caucus Chair Rep. Joe Crowley (D-NY), Rep. Gregg Harper (R-MS), Rep. James Clyburn (D-SC), and Rep. Tony Cárdenas (D-CA).

Rep. Rodgers backed the ABLE Act.  Deborah Barfield Barry reports at USA Today:

Sara Weir, president of the National Down Syndrome Society, said the ABLE Act has generated 15,000 accounts with more than $30 million in assets in 28 programs.

“The next frontier is employment," she said.

Weir said her group is working with lawmakers to craft legislation that would eliminate or change outdated laws that have income limitations for people with disabilities. She said individuals can only earn about $16,000 a year before federal disability benefits are in jeopardy.

“There are income limitations on Medicaid and Social Security that prevent people with Down syndrome from having full-time careers," she said.

Some of the laws date back to the 1930s and 1960s when individuals with Down syndrome were often institutionalized and didn't live long, Weir said.

“We want all of our individuals with Down syndrome not to just have job opportunities, but have the right to pursue a meaningful career," she said.

ACLU Suit

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.  In the case of Buckeye, Arizona, an officer harassed a young autistic man who was merely stimming.

The Buckeye scandal is not a one-off.  Though some police departments do a good job of training officers about autism and other disabilities, many do not.  The result is needless confrontation, and sometimes death.

A release from ACLU Illinois:

Seeking to ensure that concerns about interactions between Chicago police and people with disabilities are part of any reform effort, the American Civil Liberties Union of Illinois and Equip for Equality filed a federal lawsuit today with Chicago-based organizations Community Renewal Society, Communities United, Next Steps and ONE Northside. The groups seek the participation of impacted community groups in the reform of the Chicago Police Department (“CPD”), including how force is used against people with disabilities and against Black and Latino Chicagoans.

“The Police Accountability Task Force’s 2016 report and the DOJ’s 2017 report found that the CPD does not have the training or vision to ensure safe encounters with people with disabilities. This community must be part of the discussion about how to reform policing in Chicago,” said Karen Sheley, director of police practices at the ACLU of Illinois.

Specifically, the lawsuit challenges the City’s failure to train and monitor officers to ensure they safely interact with people with disabilities— one third to one half of the victims of police violence nationwide. The suit also challenges CPD’s disproportionate use of force on Black and Latino Chicagoans. For people of color with a disability, these disparities are compounded, too often leading to injury or death at the hands of the police.

“We hear regular accounts of frightening, dangerous interactions between Chicago Police and people with disabilities,” added Barry C. Taylor, Vice President for Civil Rights at Equip for Equality. “Police need the training and preparation necessary to ensure that these interactions do not occur in the future. This must be a part of police reform in this City.”

Last January, the U.S. Department of Justice issued a scathing report on the use of force by CPD officers and the failures of CPD to appropriately train and manage its officers. The lawsuit alleges that these deficiencies are causing a pattern of excessive force, encouraging a culture of cover-up, and failing to provide Chicago with a community-based policing strategy to promote public safety.

"We have a moral imperative to ensure that law enforcement officers are accountable and responsible to the communities they serve,” said Reverend Robbie Craig, Interim Executive Director at the Community Renewal Society. “True and lasting reform can occur only with community members at the table. We must act to make this inclusion a reality and not rely on vague promises from politicians."

“We deserve a police force that can safely serve and protect all Chicagoans, including residents with disabilities. CPD does not have the training and ability to achieve this goal, meaning that routine interactions habitually escalate into violence. We are proud to join this lawsuit to demand all residents be involved in oversight and reform,” added Curtis Smith, Board President at ONE Northside.

Almost nine months after the DOJ report concluded that a consent decree with an independent monitor was necessary to address the CPD’s entrenched problems, no decree has been issued nor has a monitor been appointed. Though Mayor Rahm Emanuel held a press conference in August promising to work with the Illinois Attorney General to resolve her lawsuit filed the same day, that lawsuit does not address the harm of the City’s practices to people with disabilities.

The community groups involved today also felt compelled to file suit because the City recently announced it would work with the office of Illinois Attorney General Lisa Madigan to negotiate a consent decree, yet it continues to seek dismissal of the lawsuit filed in June by black civil rights groups. Neither the City nor the AG’s office has explained how affected communities will be able to influence their private deal-making or whether they will have a role in the enforcement and monitoring of a consent decree.

“The City of Chicago cannot negotiate this agreement behind closed doors. True oversight must involve impacted communities,” said Roxanne Smith, a member of Communities United. “Communities United is committed along side our partners to guaranteeing positive reforms in the Chicago Police Department and changing how they interact with their community for the better.”

The lawsuit filed today also aims to ensure there is a long-term commitment to enforcing a consent decree. Recently, Attorney General Madigan announced she would leave office in early 2019, raising the prospect that her office’s commitment to a decree could disappear with a new Attorney General. For many, the ACLU notes, this is reminiscent of what happened after the Trump Administration took office in January and abandoned the DOJ’s plans to negotiate a consent decree on police reform in Chicago.

“People with disabilities are not currently served well by either our mental health care system or our criminal justice system,” said Fred Friedman of Next Steps. “The results get worse when those systems intersect. It is critical that the interests and concerns of those with disabilities be fully heard and considered in police reform. This lawsuit helps insure we have a seat at the table.”

“The ACLU has long history of challenging unlawful police practices and fighting for the rights of people with disabilities,” Sheley added. “We believe that this process will take years, not months, and requires stable leadership. We are ready to work with the City, the current and future Attorney General, and community groups to design and implement specific reforms. In the meantime, we urge those with disabilities who have had a bad experiences with the Chicago Police Department to contact the ACLU of Illinois.”

The Need for Police Training

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.  In the case of Buckeye, Arizona, an officer harassed a young autistic man who was merely stimming.

 As  Jim Pietrangelo writes at Healthline, the Buckeye incident illustrates the need for police training.

Healthline discussed the subject of law enforcement and autism with Elizabeth Rossiaky, a board-certified behavior analyst with the Center for Autism and Related Disorders (CARD).

Rossiaky works one-on-one with children who have autism. She has personal experience observing interactions between law enforcement and those children

“Throughout the country, you’re going to see a spectrum of officers and how they handle those situations involving individuals with autism,” said Rossiaky. “What it really comes down to is education and training.”

“The officers [in some Chicago suburbs] are required to have bachelor degrees,” she added. “They do go through more mental illness training. They go through more de-escalation training.”

However, there’s little to no standardization in levels of education and mental health training for officers throughout the country.

“Some officers have [less education] and receive maybe an eight-hour course on mental health. And that’s about it,” said Rossiaky.

Instead, “they often get way more training on how to physically manage an individual,” said Rossiaky. “That’s where you see an officer approaching a child, not knowing how to handle [them] not responding, and then the child ending up on the ground.”

Like what happened to the Arizona teenager.

“It’s because that’s where their focus lies,” said Rossiaky.

SCOTUS and Special Education

In The Politics of Autism, I write about IEPs and FAPE.

Mark Walsh at Education Week reports that the Supreme Court declined to hear a case on "stay-put" under IDEA.

In N.E. v. Seattle School District (Case No. 16-1285), the question was whether an educational setting constitutes a child's "then-current educational placement" simply because it is the placement listed in an individualized education program (IEP) drafted by the school district, even when the parents objected to the portion of the IEP listing that placement, and the child never actually attended that placement.

The U.S. Court of Appeals for the 9th Circuit, in San Francisco, had ruled in favor of the Seattle School District in the case. Lawyers for N.E., a student with attention deficit hyperactivity disorder, argued that the 9th Circuit's interpretation of the stay-put provision of IDEA was incorrect and inconsistent with several other federal circuit courts.

"The circuits exist in a state of perpetual confusion" about how to apply the stay-put provision, the Supreme Court appeal on behalf of the student said.

The justices declined the appeal without comment.

There was a different disposition for another special education case. The Supreme Court granted a California family's request to toss out a 9th Circuit decision that had upheld a federal district court's and administrative law judge's findings that a school district met its obligations under the IDEA for a student identified as E.F., who has autism and communicative delays.

The parents of E.F. said in court papers that he had made only minimal progress on his IEP's goals over four years in the Newport Mesa Unified School District, and that the lower court rulings had affirmed such a standard of minimal progress that was later rejected by the Supreme Court.

In its March 22 decision in case involving a Colorado student, Endrew F. v. Douglas County School District, the high court had set aside a "merely more than de minimis" standard adopted by another federal appeals court and held that an IEP typically should be "reasonably calculated to enable the child to achieve passing marks and advance from grade to grade."

In their Supreme Court appeal in E.F. v. Newport Mesa Unified School District (No. 16-1533), the family asked the justices to vacate the 9th Circuit's decision in their case and remand for further consideration in light of Endrew F.

And that is exactly what the high court did.

Health Care Problems

The Politics of Autism discusses health care, and explains that autism services can be complicated, creating difficulties for autistic people and their families. 

A 9/11 release from OSU Medical Center:

In a new study, researchers with The Ohio State University Wexner Medical Center's Nisonger Center found significant disparities between individuals with and without developmental disabilities in health status, health care quality, utilization, access to care and unmet healthcare needs.

A telephone survey of 42,876 adults and 10,122 proxy interviews for children found that, when comparing age groups, children and older adults with developmental disabilities experienced the greatest disparities in unmet healthcare needs.

The findings, based on an analysis of data from the 2015 Ohio Medicaid Assessment Survey, will publish online today in the Annals of Family Medicine. Among children 0-18 years of age with developmental disabilities, 14 percent reported problems receiving needed care, compared to 2 percent of children without developmental disabilities. Among adults age 65 and older, 50 percent of those with developmental disabilities reported one or more unmet health care needs, compared to 17 percent of those without such disabilities.

Key findings include that adults with developmental disabilities were less likely to have a primary care physician that spends enough time with them, and older developmentally disabled individuals were less likely to have clinicians who explained things well.

"These findings highlight the importance of disability competency for health care clinicians," said lead author Jessica A. Prokup, a third-year medical student at Ohio State's College of Medicine and a LEND fellow (Leadership Education in Neurodevelopmental Disabilities) at the Nisonger Center. "Based on our findings, we urge medical schools to incorporate specific training in developmental disabilities into their undergraduate medical curriculum to help reduce these health care disparities."

Antivax Twitter

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

Lisa Marshall writes at CU Boulder:

Anti-vaccine sentiment is alive and growing in social media, with California, Connecticut, Massachusetts, New York and Pennsylvania showing the most negative tweets of any states, according to a new five-year CU Boulder study.

In Colorado, Fort Collins ranked particularly high for the prevalence of anti-vaccine tweets. Regions around the country with high affluence and/or a large number of new moms were most likely to be hotbeds of anti-vaccine Twitter users, the study found.

“The debate online is far from over. There is still a very vocal group of people out there who are opposed to vaccines,” said study co-author Chris Vargo, an assistant professor in the College of Media, Communication and Information. “Half of the talk online that we observed about vaccines was negative.”

For the study, published in the October issue of Social Science and Medicine, Vargo and co-author Theodore Tomeny, an autism researcher with University of Alabama, created a machine-learning algorithm to examine more than a half-million tweets from around the country between 2009 and 2015. To make the sample a manageable size, they looked only at tweets that referred to both autism spectrum disorder and vaccines.
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The authors note recent outbreaks of previously eradicated, vaccine-preventable diseases like measles and pertussis have been linked to refusal to vaccinate and anti-immunization-related beliefs. A few studies have provided clues as to what drives anti-vaccine sentiment, but they have relied on small samples of people.

Vargo wanted to use expansive data sets to ask the questions: How prevalent is the sentiment online; is it growing; and where does it cluster geographically?

Between 2010 and 2015, the study found anti-vaccine tweets became, overall, more common nationwide. As the number of households that made over $200,000 annually increased or the number of women who had delivered a baby in the past 12 months increased, so did the amount of anti-vaccine tweets.

Within states, sentiment varied widely from city to city.

For instance, in Denver, 24 percent of tweets over the course of five years were anti-vaccine while in Fort Collins, 59 percent were.

Vargo stressed he does not see Twitter posts as a representative sample of overall public opinion, but rather a pulse of the level of anti-vaccine activism in an area.

Ultimately, he envisions using the algorithm to create real-time maps similar to the one developed for the study that pediatricians could use to gauge anti-vaccine sentiment in their communities.

Feds Deport Autism Dad

In The Politics of Autism, I explain how the issue connects with so many other issues.  Immigration is an example.

Anna Conkey and Wendy Fry report at NBC7 San Diego:

Federal authorities deported a Carlsbad man Thursday, despite local protests and support for his continued residence in the U.S 

Gaston Cazares was deported by U.S. Immigration and Customs Enforcement officials under the president’s new administration's policies. 

Cazares moved to San Diego illegally when he was 17 and has been in the area for nearly 30 years. Cazares’ wife of 22 years, their teenage daughter and their son with autism now remain in Carlsbad without him. 

Cazares said the experience has been a nightmare. He is concerned for his family and how he will find a job to support them in Tijuana. 

He said his son has been “inconsolable” and does not even fully understand the situation, only that they cannot be together....
An activist group in San Diego has set up a YouCaring crowdfunding page for the Cazares family.

Unproven Treatments

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

Mark Wheeler writes at UCLA:

Dr. Shafali Jeste knows well the desperation of a parent seeking a cure for their child with autism spectrum disorder. As a clinician who both researches the causes of the disorder and treats children with autism, Jeste, UCLA associate professor of psychiatry, neurology and pediatrics and a lead investigator in the UCLA Center for Autism Research and Treatment, understands why many parents will try anything that sounds reasonable. A change to a gluten- and casein-free diet to reduce symptoms. Mega-vitamins for the same. Medical marijuana to calm. Melatonin to sleep. Omega-3 fatty acids for hyperactivity. Delaying or refusing vaccinations. All done, usually, in addition to the standard medications that are prescribed to children on the spectrum, including Ritalin, Adderall or Risperdal.

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“The short answer is there simply isn’t enough solid scientific evidence to say definitely one way or the other whether most of the alternative treatments help or harm,” Jeste said.

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The autism theory most upsetting to Jeste and some other researchers is the idea of a link between childhood vaccines and autism. That now-debunked theory started in 1998, when a then-doctor named Andrew Wakefield published a study in the British journal the Lancet purporting to show a link between vaccines and autism. The study was later identified as fraudulent, was retracted by the medical journal, and his medical license was revoked.

“I think one reason this myth persists is that many symptoms of autism begin to emerge right around the same time that vaccines are given to children,” Jeste said

Behavioral interventions currently hold more hope.

One example of a behavioral therapy is one that focuses on the social communication deficits in young children with autism. It’s called “Jasper,” short for Joint Attention, Symbolic Play, Engagement and Regulation, and was developed by Jeste’s colleague, Connie Kasari.

While it’s thought that environmental factors may play some role — Jeste pointed out that the age of the parents, maternal drug use, extreme premature birth, in utero hormonal environment — her research and that of others shows that genetic variations are responsible for the majority of all diagnosed cases.

In her research Jeste searches for biomarkers that would identify autism in the youngest of patients, even babies. She is part of a nationwide, multi-center study examining preschool and school-aged children with autism spectrum disorders to identify biomarkers that could help physicians diagnose and track the disease as well as assess treatments in autism patients.