EBD Blog

The US Interagency Committee on Disability Research (ICDR) is seeking citizens’ recommendations about a research agenda. Although this initiative aims at addressing issues for adults in the community, which differs from the focus of EBD Blog (educational issues related to children and youth and their families), I want to mention it here so that readers who may have interests in health, employment, and similar topics will get the news.

This year for the first time, the federally mandated Interagency Committee on Disability Research (ICDR) is utilizing an innovative Web-based approach to collect online disability research comments to assist in developing a federal disability and rehabilitation 2010 research agenda. This technology-driven approach gives the public a three-week timeframe from March 27th through April 17th to submit their recommendations. Additionally, registered participants will be invited to review all comments submitted and vote on their top 10 concerns in each topic area during the one-week period from April 22nd through April 29th. Public comments from stakeholders are the focal point of the disability research recommendations in the ICDR Annual Report to the President and Congress.

ICDR stakeholders page.

I’ve harped on this a couple of times before, but I’m returning to it because it is very important. We have to resist the sirens’ call to ignore academic instruction for students with Emotional and Behavioral Disorders. Just as much as their peers who do not have disabilities, these pupils need to learn the skills and content that will allow them to have a reasonable chance at success in life. Reading competence is critical.

Watch this video as a refresher course:

Link to the video and to the Children of the Code Web site. Explore there.

Probably someone’s done a much more sophisticated version of this analysis, but I fiddled with it just to see what I’d find. I took the number of children identified as having Autism by the schools in each US state (as a percentage of the state’s population) and correlated that with the number of children who are immunized in each state (also as a percentage). If vaccination ==> Autism, then states where vaccination rates are higher should have higher rates of Autism, and vice versa.

The relationship between the two variables is .071, which is not a significant correlation when one has 50 pairs of scores. In fact, for the a correlation to be significant at the convention level (p < .05), it would have to be > .275.

Sources:

• The 2006 U.S. Report to Congress on IDEA, Volume 2, p. 38.
• The H. K. Kaiser Foundation’s State Health Facts data on immunizations.

Please keep in mind that I’m not offering this analysis as anything profound. There are much stronger data showing a lack of relationship between immunizations and Autism. I just happened on the data and figured I’d entertain myself with analyzing them.

Some folks may recall a few news items last fall regarding the idea that austistoid characteristics may have benefitted selected artists and scientists. Part of that interest may have arisen because of a symposium convened by the British Academy and the Royal Society. The event, called “Talent and Autism” was chaired by Uta Frith, moderated by Daniel Glaser, and featured comments by Francesca Happé, Mark Lythgoe, John Sloboda, and Joan Freeman.

The Royal Society captured the event on video and is now streaming it from the Society’s Web site. Interested readers can read more about the panel discussion and learn how to view it by following this link.

No, sorry. It’s not a briefing about the mental health of the US Senate. It’s about a briefing held in the US Senate regarding the looming problems in mental health in the US. Ordinarily I focus on issues in children’s mental health, and this may appear to be more about adults’ mental health. However, note that in many situations where adults’ mental health is an issue, there are children who are affected and who may be at increased risk because of the adults’ mental health needs.

Thanks to US Senator Debbie Stabenow for helping make this briefing happen.

ON THE FRONT LINES OF AMERICA’S PUBLIC MENTAL HEALTH CRISIS

Mental illness is the leading cause of disability in our nation. While Community Mental Health Centers and other front line safety-net providers are doing their best to respond to the needs of low-income persons with mental health disorders. They are confronted by both short term and continuing crises.

Our public mental health system is facing an immediate fiscal challenge: media reports this year indicate that as many 32 states are contemplating mental health funding cuts, including hiring freezes and community-based service reductions.

The ongoing challenge is to provide a response delivery system that allows persons with mental illness to access both the behavioral and physical health care they so urgently need. Adults with serious mental illness are dying, on average, 25 years earlier than the general population. In early March, for example The New York Times reported that hospitalized person with bipolar disorder have mortality rates that are 35% to 200% higher than other hospital patients.

On Tuesday, March 31, from 12:00 – 1:30 pm in Room SVC 208/209 of the Capitol Visitor Center, Senator Debbie Stabenow will host a briefing titled “On the Front Lines of America’s Public Mental Health Crisis,” to discuss challenges facing community mental health and efforts to address them – often through programs that integrate mental health and primary care services.

>>snip…< <

Panelists:

Linda Rosenberg, President and CEO
National Council for Community Behavioral Healthcare

Cindy Kaestner, Vice President
Abbe Center for Community Mental Health, Cedar Rapids, Iowa

Patrick Barrie, Interim Director
Washtenaw Community Mental Health Organization, Ypsilanti, Michigan

Helen Royal, Grant Coordinator, Advancing Colorado's Mental Health Care Initiative for Summit County Colorado and Behavioral Health Services, Frisco, Colorado

Karen Wyatt, MD, Medical Director
Summit Community Care Clinic, Frisco, Colorado

Malkia Maisha Newman, Community Educator
Community Network Services, Farmington Hills, Michigan

The recently published study by Rossignol and colleagues about hyperbaric oxygen therapy (HBOT) for Autism has generated lots of commentary and is sure to lead to more. Because it is a treatment study and employs more careful methods than are common in many of the therapies promoted these days, I sat up and said, “Hmm. I ought to read this one.”

So I did. And I found it to be, indeed, a cut above much of the ersatz research that’s passed off as evidence in the Autism arena. But, I found some concerns, too.

Those concerns led me to poke about a bit on the Internet to see whether there were any others who were raising questions. There are. And I still have some more poking to do. But, I thought I ought to record my concerns. Thus this post.

Continue reading ‘Does Rossignol et al. show HBOT’s effective?’

Although insurance carriers in California must pay for some services, in a memorandum to insurers Monday 9 March 2009 insurance regulators in California indicated that insurance coverage does not have to extend to applied behavior analytic (ABA) treatment for children with Autism. According to Lisa Girion, the memorandum from the Department of Managed Health Care requires insurers to pay for speech, occupational, and physical therapy, but not for educational services aimed at improving daily living skills.

The letter is focused on “ensuring that individuals with Autism Spectrum Disorders (ASD) receive the care they are entitled to under the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act) and accompanying regulations.” It requires that insurers maintain a network of services for evaluation and referral of individuals with ASD that conforms to, Knox-Keene Act. This part addresses screening, diagnosis, qualified providers, and so forth. Under the head “Part B: Treatment for Persons with ASD,” the letter reads

Health plans must do the following:

Cover all basic health care services required under the Knox-Keene Act, including speech, physical, and occupational therapies for persons with ASD, when those health care services are medically necessary.

>>…snip….< <

2. Provide mental health services only through providers who are licensed or certified in accordance with applicable California law.

3. May not categorically exclude any particular health care treatment or therapy for Autism Spectrum Disorder.

So, ABA cannot be expressly denied. As Ms. Girion reported, it must be that the focus of the treatment (e.g., self-care, head banging) that are not considered legitimate targets for mental health. One has to wonder whether speech therapy predicated on behavior analytic principles—and most of the effective speech therapies for children with Autism are based on ABA principles—will become a target.

I have little trouble considering healthy living a mental health issue. Of course, I’m biased, but that might be the path to take. As Ms. Girion notes and the memorandum reads, the Department of Managed Care still requires a process for review of appeals by independent medical providers.

Links to Ms. Girion’s story, “Autism patients in California are dealt insurance setback,” and to the CA Department of Managed Care memorandum.

Jack Leonard and Richard Winton reported that a California police department will investigate whether an officer who used a taser stun gun to subdue a boy with Autism acted according to police guidelines. The investigation was prompted by a complaint from the boy’s parents. Under the headline “Hawthorne police review use of Taser on middle school student,” Mr. Leonard and Mr. Winton recount the incident from September of 2008 when Officer Vincent Arias tased the 12-year-old boy who had assaulted a teacher and a school security guard.

Lt. Michael Ishii said police were called to Hawthorne Middle School after a student grabbed a counselor in a threatening manner and punched and kicked a security guard who intervened. The boy, described as about 5 feet 7 and 130 to 150 pounds, threatened to kill staff members and continued assaulting the guard, who tried to protect other staffers, Ishii said.

“He bore the brunt of the assault,” Ishii said of the guard, who was knocked to the ground at one point. “He was doing his best to block the kicks and punches.”

Officer Vincent Arias arrived at the school about 11:30 a.m. The boy, whose name was not released, continued behaving violently and kicked Arias in the groin as about 200 students looked on from the school grounds, Ishii said.

School officials called the boy’s adult sister to the site but she was unable to calm him, Ishii said. Arias, he said, fired a hand-held X26 Taser when the boy dashed toward the school’s exit and the area where the other students were in a physical education class.

Link to Mr. Leonard’s and Mr. Winton’s story from the Los Angeles (CA, US) Times. Read previous posts on EBD Blog about use of force by police to subdue children with Autism from 21 September 2007 and 22 August 2006.