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Sacramento County Schools “See” The Invisible Epidemic

5 Sep

At the end of this past week, California’s Sacramento Bee reports that “Autism rates quadruple in local schools over last decade“. The article, written by Phillip Reese, seems largely unremarkable. Even though headline is suggestive, there are no claims of “autism epidemic” that follow. In fact, Reese points out that:

Whether autism is actually more prevalent — as opposed to just more frequently diagnosed — is a matter of controversy.

From a scientific perspective, Reese definitely could have dug a lot deeper, but to a casual reader, the relevant facts seem pretty accurate, and a clear chart is provided.

The problem with an article like this, is that to a casual reader it may appear that there doesn’t seem to be any explanation in sight. “Autism is on the increase in Sacramento County Schools for the past decade”, and that’s that – “Why” is some sort of “controversy”, “some districts have more autistic students than others”, “here’s a chart”, and the article ends.

Did the Sacramento Bee miss an opportunity to carry their headline further, and expose an acutal “autism epidemic” in northern California schools?

Not surprisingly, Age Of Autism (always on the lookout for support of the notion that there’s been an autism “epidemic”) thought so. As it turns out, AoA resisted the urge to dig much deeper too. They were apparently satisfied to present a simple retort to the indication that whether or autism is actually more prevalent or more frequently diagnosed is “controversial”.

Seems the SacBee hasn’t read the study from their own state U that said, A study by researchers at the UC Davis M.I.N.D. Institute has found that the seven- to eight-fold increase in the number children born in California with autism since 1990 cannot be explained by either changes in how the condition is diagnosed or counted – and the trend shows no sign of abating.

Emphasis AoA’s.

If you think the emapahsized quote above sounds more like a press release than an acutal study, you’d be correct. Does the quoted press release overstate the actual conclusions of the study?

I’ll let readers be the judge of that, here’s the actual study’s conclusion:

Autism incidence in California shows no sign yet of plateauing. Younger ages at diagnosis, differential migration, changesin diagnostic criteria, and inclusion of milder cases do not fully explain the observed increases. Other artifacts have yet to be quantified, and as a result, the extent to which the continued rise represents a true increase in the occurrence of autism remains unclear.

Emphasis mine.

As foreshadowed for us in the conclusion of the actual study, what other artifacts might there be, that have “yet to be quantified”? Big ones like changes in awareness or diagnostic substitution?

Let’s quantify one of those potential artifacts (diagnostic substitution) for the Sacramento County Schools data, shall we?

Here’s the data (available online to the public):

To sum things up, I think Reese’s article/blurb would have been more interesting, only requiring a few extra minutes (the data is already there, presented on the same page when looking up the autism numbers), if it had included information about other changes like the “more than offsetting decrease” of Specific Learning Disabilities over the same time period.

Tell us what you think? Could newspapers do better when reporting on autism data, or do they simply present what their readers are really looking for?

Additional reading on this subject:

California’s Invisible Autism Epidemic (Jan 2009)

California’s Invisible Autism Epidemic Continues (Feb 2010)

California’s Specific Learning Disabilities Counter Epidemic (Feb 2011)

Prof. Paul Shattuck: ASD outcomes in adulthood

2 Sep

Below is a presentation given at the last IACC (Interagency Autism Coordinating Committee) meeting. Prof. Shattuck has done some excellent work in recent years. He’s one of the people looking into the areas I find critical and underserved. If you want to hear about research which can have a real impact on the life of this generation of autistic youth, you should set aside the time to listen to this talk.

Prof. Shattuck is looking at the critical transition from school to adulthood. How well are autistic students making that transition (largely, not so well as it turns out). What are the factors that help make that transition successful? If we don’t look into these questions today the problems will only continue unresolved.

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Grand Jury says special education underfunded

1 Jul

This sounded like it could be a good news story. Grand Jury says special education underfunded is a news story out of Ridgecrest California. (If you aren’t familiar with the geography, Ridgecrest is in the southern part of the Owens River valley north of LA in what would be a desert/rural area except for China Lake military base and Edwards Air Force Base).

I was hoping for something in the story pointing out that the amount of money going into Special Education was too low. Not that I want to hear that our good friends in Ridgecrest but, hey, I assume they aren’t getting the funding they need in these tough times.

The story starts out with the cost of Special Ed in the district:

The Sierra Sands Unified School District spent nearly $4.14 million for special education, and nearly $421,000 came from the district’s general fund, according to a just-released Kern County Grand Jury report. The district also spent nearly $11,000 for transportation.

They then make a statement I see all too rarely:

The report said the children of California are entitled to a free and appropriate education by court and legislative mandate.

They got it right. The children of California are entitled to a free and appropriate public education (FAPE). Not “the special education students” as is all too often the focus. No, all children are entitled to FAPE.

We just don’t hear people complaining about the mandate to provide FAPE to non special ed students. And this is where the story starts down that path:

“Like many mandates, the mandating authorities do not fully fund the mandated services,” the report stated. “In 2010-11, the Kern County Grand Jury studied all of the school districts in Kern County to determine costs above and beyond the funds that come to them from the state and federal governments for special education.”

Guess what. The districts pay more for regular students than they get from state and federal government allotments, too. Heck, from what I’ve seen, the state and federal governments don’t live up to their commitments to the mainstream population either, leaving the local governments to backfill.

The term “unfunded mandates” is used a lot. In some ways, it might be better if the IDEA hadn’t promised any money to the local school districts. That way the focus would be on the term “mandated”, not “unfunded”. Then we could ask a simple question: why does the federal government have to mandate that special education students receive an appropriate education? Shouldn’t it be just assumed that all children have a right to an appropriate education? Why do we even question this for special ed students?

You can read the rest of the story. It’s short. But again, I have to ask, why do we have to mandate an appropriate education for special education students? Why single them out? Everyone deserves an appropriate education.

My IMFAR poster

1 Jun

I was fortunate enough to attend IMFAR this year on an Autism Science Foundation stakeholder travel grant. This is the second year of the program, and I hope that they continue it. Given that, I thought it would be valuable to write about my day-to-day experiences: Looking back at IMFAR from an ASF Stakeholder Travel Grant Awardee

I have to admit, my experiences were probably out of the ordinary for a stakeholder travel grantee. I hope that many or even most will be people who are not familiar with scientific conferences (I have attended several over the past 20 years). I do hope that more bloggers attend and report back, though, so experiences with the press conference could be of value.

One aspect of my IMFAR visit that I didn’t discuss in detail on the ASF blog was that of presenting a poster. My topic was:

Parent Reported Status and Expectations for Their Autistic Student Children:
An Analysis of the 2007 National Household Education Survey

Here’s the abstract:

Background: National surveys provide a good source of information on autistic populations within the United States. The 2007 National Survey for Child Health was used to estimate autism prevalence (Kogan 2009), as well as to make comparisons of such family factors as the divorce rate (Freedman 2010). A similar survey, the National Household Education Surveys Program (NHES), is an opportunity to explore comparisons between parent-reported factors involving the lives and education of autistic and non-autistic students.

1. Compare educational placements and percieved educational abilities between children with (a) parent-reported autism spectrum disorders (ASD) and (b) children in the general population.

2. Explore parent expectations for the future of their ASD student.

Methods: Data used for this study were taken from the National Household Education Surveys Program (NHES 2007). NHES had 10,682 total respondents, representing students ages 3 to 20 years. 127 parents identified their child as having autism and an additional 37 identified their child as having pervasive developmental disorder.

Parent responses for this group (164 total, or about 1 in 65) were compared to those of the parent responses within the general survey population.

Results: 75% of students with parent-reported ASD have an Individualized Education Plan. Parents reported that their ASD students are more likely to have repeated a grade (23% ASD vs. 9% without) or be home schooled (5.5% vs. 2.9%) or be in a program that does not assign letter grades (37% vs. 22%). ASD students were reported as less likely to be in private school (9.6% vs. 13.4%) and to have moved in order to attend a specific school (17.7% vs. 21.6%). Parents are generally satisfied with their child’s school (82.2% rated somewhat or very satisfied), but less so than for non-autistic students (90.7%). Of those children who receive letter grades, the number of ASD students getting “mostly A’s” or “mostly B’s” is high (79.6%), but less than the general population (84.1%). Parents of students in middle school or above were asked about their future expectations. The fraction of ASD students whose parents’ expectation were that their child would receive less than a high school diploma is much higher than for the general population (6.3% vs. 0.6%). However, by far the majority of parents expect their autistic student to receive a high school diploma, with most expecting at least some vocational school or college to follow. Most parents in the general population expect that their child would achieve a 4-year or graduate degree (72.7%). While the parental expectations for ASD students to obtain a bachelor or higher degree is much lower (28%), this is still a notable fraction of the autistic population.

Conclusions: Parents report that their ASD students lag behind the general student population in academic performance. Parent report high satisfaction with their schools, but at a lower level than the general population. Many parents of ASD students report high expectations for their ASD students. Services research should consider how to support individuals with ASD with a broad spectrum of abilities and expectations.

Here’s the actual poster:

Imfar poster 2

If you are unfamiliar with a poster presentation, here’s the short version: You take your study and write it up on a 3′ x 4′ piece of paper. You stand in front of the poster and discuss it with the people who are interested.

I was very lucky in that I was right by one of the doors, so a lot of traffic came my way. That traffic included a few people who knew me from my blogging here. One reader came up and said “Hi Sullivan!”. A group from Kennedy Krieger stopped by and told me they wanted to take a picture of the poster to show their colleague–who I was citing in my work. I don’t think they are used to people saying, “You guys from Kennedy Kreiger rock!”, but they got it from me. I spoke with a researcher I know who worked under Ami Klin (formerly of Yale, now at Emery), whom I got to meet there too.

I was scheduled for the 10am time slot on Friday. This means I had to duck out early from Eric Courchesne’s keynote talk. I spoke with him later and he asked me about his talk. I told him it was very good and he responded with the killer question: what did I think of the last 15 minutes? I had to admit that I was standing in front of my poster then and missed his conclusion. To which he responded (with a bit of a mischievous grin, if I may say): you missed the best part! as he disappeared through a door.

I was scheduled for 1 hour. Posters can be a bit tedious when you stand there waiting for someone to talk with. I was lucky in that I went pretty solid for 2 hours.

A poster presenter needs to have the 1 minute “walk through” of the study. Mine was basically this: A lot of work has been focused on the National Survey of Children’s Health (NSCH). This is the study which formed the basis of one of the “autism prevalence is 1%” last year. There didn’t seem to be much focus on the educational survey which I presented, and I was there to make it known that there was this other data source. I didn’t dwell too much on the prevalence (1 in 65) or the fact that the prevalence was basically flat with age (Figure 1). What I found interesting was the fact that there is a very wide range of parental reports of abilities, difficulties and expectations for their kids. Yes, by every measure shown, autistic students are more likely to be in ungraded classrooms, get lower grades, have reports of behavior problems and the like. But a notable fraction are being parent-reported as getting “A’s”. Most parents expect their children to graduate high school (over 90%) and many parents expect some college or even graduate school. Those last questions were only asked of parents of children in middle school and above, so they had some basis to make the predictions.

I pointed out that there is no way to see how realistic the parent’s expectations were (and that there was a far more rigorous study being presented at IMFAR on the transition out of school for autistic students–that of Paul Shattuck’s group in St. Louis–and that expectations exceed reality). The first person to look at my poster noted that 30% of parents of children overall (the general population) were expecting their kids to go to graduate school, which shows that all parents are proud of and optimistic about their children.

There was a wonderful presentation on the poster next to mine by a team from Georgia Tech. I hope to include that team’s work in a later post.

I am very grateful that IMFAR accepted my abstract. I went in with the idea that my poster might be the least interesting study presented. In the end, if I do say so myself, I held my own. Sure, it’s not earth shattering research. But there were interesting points. For me it was a great experience, even if it meant a flashback to my grad school days of standing in front of a poster.

That’s not for our kids

28 Apr

A recent Guardian Roundtable touched on an interesting subject for those of us who are responsible for children with learning difficulties. The article was written, sourced and published in the UK but I believe it applies everywhere in the world where there are children with learning difficulties.

Just 6.4% of people with learning disabilities are in paid employment and that stark statistic – and the shocking waste of financial (and human) resources behind it – formed the backdrop for a recent Guardian roundtable discussion.

This issue has its root, I believe, in the way we are led to think about our children from birth:

When it comes to setting expectations for a child with learning disabilities, things can start to go wrong the moment they are born. The roundtable heard how health staff use their “breaking bad news” training to counsel parents, leaving them with the impression that there’s not much incentive to look forward to the future.

I remember the day we received the news that our child was autistic with profound learning difficulties. There were 3 calm staff members and a box of tissues on the table. By the time we left, the tissues had been used – and although the staff were gentle, kind and wonderful people who clearly were fond of our child – they too fell into that trap of ‘breaking bad news’ mode. A mode that, by its very tenor, fulfills the expectation of _being_ bad news.

The truth is, in my opinion, that with a little effort from health care agencies we can move from:

staff at one special school who, when the issue of employment was raised, replied: “That’s not for our kids.”

to a de facto position as espoused by agencies like Remploy who are the UK’s leading provider of employment services to people with disabilities.

But we’re not anywhere near that yet. In my own experience too many parents of people with special needs are content to wallow in the comfort of ‘putting it off’ – their children are still young. But consider this – we are far longer a time adults than we are children. Our children need to learn how to function in the world. This won’t be brought about by sham cures and ideaslistic fights against a strawman army. Neither will it be brought about by those who insist on misrepresenting the nature of what autism is to all rather than some.

One speaker summed up the fundamental question underpinning the whole debate: “Do we believe that people with learning disabilities and their families are worth it?”

Are they worth the upheaval and political effort it would take to transform a system that often fails them when it come to finding work?

In any society that claims to be fair, children with learning disabilities surely deserve the same life chances as other young people, the roundtable heard. They should be encouraged to have ambition

Federal government denies Oregon waiver on special education cuts

15 Apr

In the US the Federal Government pays a part of the costs of special education. They are committed to pay 40%, but typically have spent about 17%. If a state reduces special education spending, the federal matching funds are also reduced. That is, unless the state is granted a waiver. So far the federal government has been granting the states waivers as they ask for them. In other words, the states cut special ed funding, but the government doesn’t cut the amount they pay in.

That’s what’s happened until now. Oregon has been denied a waiver. In Feds say Oregon must boost special education funding or face sanctions, points out:

The U.S. Department of Education has denied Oregon’s request to reduce special education funding in light of budget cuts and will cut more than $15 million federal funding to schools if the state doesn’t reverse course.

States lose federal special education money if they lower their contribution to those programs without a waiver. Oregon Department of Education officials sought the federal waiver, saying the state faced declining revenue projections throughout the summer, forcing the department to reduce the amount of money supporting special education programs.

But the federal government didn’t see things the same way. U.S. Department of Education officials say Oregon needs to tap into its reserves and return special education funding to 2009-10 levels. If it doesn’t, the federal government will reduce its contribution to the state by $15.7 million for the 2011-12 school year – a direct reduction to local school district budgets.

I am very mixed on this. Yes, I think the federal government should try to push states to maintain special ed funding. Unfortunately, this could cost an additional $15.7M to the state’s special education budget.

Alabama given permission to cut special education funding

13 Apr

We’ve discussed it before: some states are starting to ask for waivers from the federal government to allow for reductions in special education funding. From Federal goverment to let Alabama cut spending for special education. Here’s the first few paragraphs:

WASHINGTON — Ala­bama is one of a handful of states given permission to cut spending on special ed­ucation this school year, a rare concession from Wash­ington for states facing se­vere shortfalls in their state budgets.

State education officials had asked to spend $9.2 mil­lion less on education pro­grams for disabled children than last year, a 1.45 percent drop.

In a response letter dated Thursday, federal education officials said they were will­ing to waive the insulation that special education pro­grams normally have from cutbacks because the reduc­tion was a fraction of the cuts made to the rest of the education budget.

Alabama reduced its over­all spending on education by 8.41 percent in the 2010-11 fiscal year — 8.46 percent in elementary and secondary education.

The federal governement will give the same amount to Alabama for special education:

If the waiver had been rejected, Washington would have reduced the amount of money it sends to Alabama for special education next year by $9.2 million. Washington said it expects Alabama to spend about $635 million on special education in the 2011-12 year, which would have been the budget before the waiver was granted.