Research reveals racial differences in perceptions of autism prior to diagnosis
January 25, 2022
A study published recently in Autism reveals racial differences in the way parents think about autism spectrum disorder (ASD) prior to their child’s diagnosis.
Researchers studied 489 children between ages 1 and 15 at their first ASD evaluation. Participants were 48% white, 23% Black/African American, 10% Asian, 6% Hispanic and 13% multiracial or other.
While all parents came to the evaluation with concerns related to their child’s communication, social and emotional/behavioral challenges, parents of white children were more likely to suspect that their child had autism than parents of multiracial, Black, Hispanic and Asian children.
Further, the results showed that white children whose parents believed they had ASD prior to a diagnosis had less severe symptoms. However, in other racial/ethnic groups, early parent knowledge of ASD was not associated with better outcomes.
These results could reflect disparities in access to medical knowledge and education among minority communities. White parents overall have greater awareness of ASD than people of color, leading to earlier interventions and better outcomes for their children. In contrast, racial/ethnic minority parents are less likely to believe their child has ASD, delaying access to care.
The findings may also imply the existence of structural racism and provider bias in the healthcare system. Racial/ethnic minority children had worse outcomes than white children even when their parents were equally knowledgeable about ASD prior to diagnosis, indicating differences in the quality of care.
Additionally, the research showed racial differences in the types of concerns that led parents to seek out an autism evaluation for their child. Parents of Black and Hispanic children were more likely to have concerns about their child’s communication issues, while parents of white children were more concerned about their child’s emotional/behavioral skills. Hispanic children whose parents reported that their child did not make eye contact or respond to their name were more likely to get an ASD diagnosis and experience severe symptoms.
It is possible that for minority parents, “communication” may serve as an umbrella term that encompasses other ASD symptoms like social skills and cognition. ASD screening and assessment practices should take this into account, paying particular attention to communication concerns among parents in Black and Hispanic communities. Providers who are educating minority families and raising awareness of ASD should also focus on early social communication challenges as a key symptom.
Autism diagnosis has become more common, but pandemic disrupted early detection, CDC says
The rate of children diagnosed with autism in the United States has been growing steadily since 2000, but two new reports from the US Centers for Disease Control and Prevention highlight disparities in the types of children identified to have autism spectrum disorder and setbacks in early detection.
In 2020, about 1 in 36 children had been diagnosed with autism by age 8, according to the CDC – about 2.8%. That’s up from a prevalence of 1 in 44 children in 2018 and 1 in 150 children in 2000.
But according to the CDC, this long-term trend has “largely been interpreted as improvements in more equitable identification of (autism spectrum disorder), particularly for children in groups that have less access or face greater barriers in obtaining services.”
For the first time, diagnosis was more common among Asian, Black and Hispanic children than it was among White children. The CDC researchers note that this shift “may reflect improved screening, awareness, and access to services among historically underserved groups.” In fact, between 2018 and 2020, autism prevalence rose more than twice as fast among Asian, Black and Hispanic children than it did among White children.
These findings are based on surveillance data from 11 communities that participate in the CDC’s Autism and Developmental Disabilities Monitoring Network. The data are not nationally representative and vary widely by location – from a prevalence of 1 in 22 children in California to about half as many in Maryland. The CDC says more research is needed to understand this variation, which could be related to differences in the strategies used to identify and diagnose the condition.
Still, some trends have stayed consistent.
Autism prevalence is significantly higher among boys than girls – in 2020, there was about a four-fold difference. But it was the first year that more than 1% of 8-year-old girls had been diagnosed with autism.
Also, disparities persist in identifying autism in children who also have an intellectual disability. In 2020, more than half of Black children diagnosed with autism also had an intellectual disability, compared with less than a third of White children. According to the researchers, this finding suggests a need to better detect and evaluate developmental concerns beyond cognitive ability.
Generally, children who have intellectual disabilities are more likely to be diagnosed with autism earlier. But early detection is important for all children with autism, as it helps connect them with helpful resources and interventions.
In recent years, good progress had been made in early detection of autism – an earlier CDC report found that children born in 2014 were 50% more likely to receive an autism diagnosis or special education by age 4 than those born in 2010.
Another new report published by the CDC on Thursday shows that there was evidence of continued improvement in these trends through February 2020, but the trends reversed as the Covid-19 pandemic hit with “sustained lower levels” of evaluations and identification of autism across most of the surveillance network.
In first six months of the pandemic, there were 217 fewer evaluations for every 1,000 children at age 4 than there were four years earlier. There were also nearly three fewer identifications for every 10,000 children, according to the CDC report.
“Disruptions due to the pandemic in the timely evaluation of children and delays in connecting children to the services and support they need could have long-lasting effects,” said Dr. Karen Remley, director of CDC’s National Center on Birth Defects and Developmental Disabilities. “The data in this report can help communities better understand how the pandemic impacted early identification of autism in young children and anticipate future needs as these children get older.”
Key Findings: Progress in Early Identification of Autism Spectrum Disorder, but Gaps Remain.
A study from the Centers for Disease Control and Prevention (CDC) assessed progress in early identification of autism spectrum disorder (ASD) in the United States from 2002 through 2016*. There have been concerns about lack of progress in early identification because the age when most children with ASD get their diagnosis has not changed much over time. This study used a different method to measure early identification that better captures progress and gaps.
ASD identification by age four years was four times as likely in 2016 as in 2002. This indicates that there has been improvement in early identification. In addition,
- Identification of children without co-occurring intellectual disability improved; and
- Children of every race and ethnicity were more likely to be identified over time.
Differences in early ASD identification exist based on whether children have co-occurring intellectual disability.
- Black and Hispanic children without intellectual disability were 30% less likely to be identified with ASD by age four years in 2016 than White children.
- Black children were 50% more likely than White children to be identified with ASD and intellectual disability by age four years in 2016.
- These findings could reflect differences in social determinants of health, which include factors such as socioeconomic status, housing, physical environment, and experiences with racism and racial discrimination.
Continued efforts are needed to ensure all children with ASD are identified early so they can receive services they may need to support their development as soon as possible.
*Estimates were based on data from 8-year-old children in sites participating in the Autism and Developmental Disabilities Monitoring Network surveillance years 2002 through 2016. “Identification” refers to either an ASD diagnosis or special education classification.
New insights into the sexual health and activity of autistic adults and adolescents
November 15, 2021
New research published this autumn in Autism Research, the official journal of the International Society of Autism Research, reveals significant differences in sexual orientation and activity between autistic and non-autistic people across the lifespan. As the largest study on the sexuality of autistic adolescents and adults, these results may have important implications on sex education and healthcare in the autistic community.
Using an anonymous, self-reported survey, researchers collected data about demographics, autistic traits, lifestyle information and medical history from a sample of 2,386 individuals (including 1,183 autistic individuals). The sample primarily consisted of females, white individuals, UK residents and those without intellectual disability, and participants ranged in age from 16 to 90 years, with an average age of 40.
Overall, the results show that while the vast majority of both autistic and non-autistic respondents reported having been sexually active, people with autism were less likely than non-autistics to report having ever engaged in sexual activity—and this is particularly true of autistic men.
However, while autistic adolescents and adults are less likely to engage in sexual activity than non-autistic adults, they are more likely to have diverse sexual orientations. People with autism were 8.1 times less likely to identify as heterosexual and 7.6 times more likely to identify as asexual or “other” compared to non-autistic people.
In particular, autistic males were more likely to identify as bisexual compared to non-autistic males, while autistic females were more likely to identify as homosexual compared to non-autistic females. Older autistic adults were also more likely to identify as bisexual compared to older non-autistic adults, whereas younger autistic adults are more likely to identify as homosexual compared to non-autistic peers of similar age.
Comparing males and females with autism reveals additional complexity. While there were no significant differences in the average age of sexual activity onset between autistic and non-autistic groups, autistic females report greater sexual diversity than autistic males and were more likely to engage in sexual activity at a younger age (18.02 in females versus 19.44 in males).
Interestingly, these differences do not affect sexual health outcomes. Autistic and non-autistic groups did not differ in their risk of contracting a sexually transmitted infection (STI).
These findings may have important clinical implications for people with autism, particularly relating to sexual health screenings, sexual education and mental health support. Because autistic individuals are more likely to identify as LGBTQA+, they are more vulnerable to inadequate healthcare and worse mental and physical health. Improving sexual education and delivering regular sexual health screenings for autistic adolescents and adults across the spectrum should remain a priority. Practitioners providing these screenings should ensure that they use language that is inclusive of all genders and sexualities and actively support autistic individuals who may be at increased risk of stress and discrimination due to their intersectional identities.
New Texas ABA Medicaid benefit takes effect February 1
January 28, 2022
Effective February 1, 2022, Applied Behavior Analysis (ABA) is a covered benefit for Medicaid enrollees in Texas who have autism spectrum disorder (ASD). This new ABA Medicaid benefit has taken years of advocacy by Autism Speaks and advocates across the state who care about making Texas a better place for those affected by autism.
ABA is the acronym for “Applied Behavior Analysis.” It is an evidence-based behavioral therapy for those with ASD and one of the most common interventions for people with autism. Learn more about ABA.
The path to coverage under Medicaid for ABA services has been long and not without its challenges. On June 15, 2019, Governor Abbott signed the budget bill which included a requirement for Texas Medicaid to cover medically necessary care, including ABA, for all Texas Medicaid-enrolled children. Unfortunately, due to COVID-19, the implementation of coverage for autism services was delayed. During this time Autism Speaks has continued to work toward effective implementation, and we are now happy to share more information about how to access and use the new benefit.
Details about accessing the Medicaid ABA benefit:
- The individual enrolled in Medicaid must be under 21 years old. Currently, CHIP enrollees are not eligible for the benefit. However, Medicaid Buy-In enrollees are eligible. To learn more about Medicaid and the Medicaid Buy-In program, visit here.
- The individual needs to have been diagnosed with ASD within the last 3 years.
- A doctor or other medical professional (for example, a psychologist or nurse practitioner) needs to make a referral (prescribe) ABA for the child.
- ABA providers who are accepting Medicaid clients will be in the online provider directory of the child’s health plan. Search for “licensed behavior analysts” or “autism services.” Check the back of the child’s Medicaid card for plan information.
- Because ABA is a brand-new Medicaid benefit, we expect there may be some hiccups along the way as it is rolled out. We also expect that there will be a shortage of providers who are accepting Medicaid clients. For these and other concerns, please contact the child’s Medicaid service coordinator or the state’s Behavioral Health Ombudsman and ask for help. Texas families have waited so long for this benefit & we want to help the state address any problems as quickly as possible.
10 Tips for Teaching Young Children with Autism Spectrum Disorder
Top Tips to Help You Get Started
All children have unique learning needs, but children with Autism Spectrum Disorder or ASD require a little extra guidance and support.
These 10 tips will help you get started:
1. Create a Structured Environment – Children with autism feel more comfortable when they have a routine with clear structures, and minimal deviations from their predicted schedule. Make sure the learning environment and lesson plans are structured in a manner that tells students as well as educators what is to be done, for how long or how much, when it needs to be done, when it is completed, and what comes next.
2. Make Communication Easier – Many communication techniques are used by educators who teach children with ASD. For instance, some learning centers use sign language for autistic children with low speech skills. Facilitated communication is another technique that may help them learn better, where you hold the child’s hand or arm and encourage them to press the appropriate key on portable communication devices.
3. Use Visual Aids – Visuals are an important aspect of teaching young children, particularly for children with autism. Line drawings, photographs or Language Builder Picture Cards, “if/then” cards and stickers can be incorporated within various daily activities, while picture schedules and mini-schedules provide structure. Other tools such as online tutorials and videos deliver information in a visual manner that a child with ASD may find easier to absorb.
4. Encourage Social Interactions – You need to help children with ASD develop the knowledge and skills required for social interaction, both at home and in school. A child with autism may not seem interested in interacting with peers, parents and teachers, but it’s important to keep teaching them social skills. Classrooms provide the perfect setting, and childhood educators should build an environment that encourages children to practice communication skills. Try using the Stages Learning Emotion Cards to help children identify and learn to interpret facial expressions.
5. Make Activities Structured Too – Providing structure within various activities can be effective at helping children with ASD learn better. Use visuals to provide the child with information for each task or activity, in the same manner as lesson plans and daily schedules. For instance, a timer can tell them how long each activity will take. Include opportunities for peer interaction as well, to help children improve their social skills.
6. Use Direct Language – Young students with ASD may not understand abstract concepts or figurative language, and they tend to take most things literally. Non-verbal cues, such as facial expressions and gestures, may not make sense to them at all. If you’re used to teaching children who don’t have autism, it can take some time to get used to the right wording for what you want to say. Practice being as direct as possible.
Whether you’re a parent or teacher, it’s essential to understand what a child with autism needs and how you can help them learn better..
7. Give Them Extra Time – Even when you use direct language, a child with ASD may not be able to respond or react right away. Give them extra time to absorb what you’ve said, and process it at their pace. Patience is a key when you’re teaching autism children. If you try to hurry the child or rephrase your instructions, statements or questions, you will only slow them down further as they start reprocessing.
8. Be Aware of Sensory Issues – Children with autism are either over-sensitive or under-sensitive to sensory stimuli the rest of us don’t even notice. For instance, they may be bothered by perfumes and other smells, certain lighting, or even the buzzing of electrical appliances and echoes from other areas. This leads to extreme reactions and from learning, so remain aware of potential triggers and avoid them as far as possible. Provide children with sensory tools to help them reduce stress and process information being communicated to them.
9. Eliminate Potential Stress – Children with autism don’t react well to changes and disruptions to their routine, so use transition warnings, visual schedules and clear instructions to help set them feel at ease. Remember, positive reinforcement is far more effective than threats or punishments, which are likely to cause anxiety and behavioral issues. Focus on building a positive learning environment where they feel safe and comfortable.
10. Keep Instructions Simple – Complicated strings of directions can be difficult for any student to follow, but particularly so for children with ASD. Many struggle with processing oral language, so you break down instructions step-wise, and avoid giving them more than one or two at a time. Make sure you’re using short sentences and simple but clear language, allowing the child enough time to process each step and respond.
Consult a doctor or therapist if you need guidance, research new techniques for teaching children with autism, and try a few different methods to gauge how effective they are for each child. Most importantly, don’t lose patience. With a little practice and effort, you’ll find what works best for them!
*Republished from original article*
How can teachers support students with autism in the classroom
Students with autism often present unique challenges to schools, and teachers can often find it difficult to meet their needs effectively.
Internationally, around 1 in 68 children are now diagnosed with an autism spectrum disorder (ASD). ASD is a developmental disability that can cause significant social communication and behavioural challenges.
A recent study found that among the 934 parents who were surveyed, approximately 77% had children on the spectrum attending mainstream schools.
It also found that, in general, teachers only felt slightly confident in their ability to support students with autism, while parents were even less certain of teachers’ confidence to teach their children with autism.
Teachers, then, need to have a better understanding of autism and how it may affect learning. They also need help putting appropriate strategies in place.
Impact of autism on a student’s life
Every person on the autism spectrum is unique and their needs will be reflected differently.
Challenges experienced interacting socially and communicating with others are common among students on the spectrum, and will have an impact on every aspect of their lives.
These challenges can lead to levels of stress, anxiety and depression that are much higher than for other students. Up to 72% of students on the autism spectrum have additional mental health needs.
Classrooms are social environments that rely heavily on being able to interact, socialise and communicate with others effectively. This can intensify the stress, anxiety and depression students on the spectrum may experience.
This can present unique challenges for schools and teachers, with students on the spectrum being four times more likely than their peers to require additional learning and social support services.
Research shows the importance of understanding the link between academic learning and social and emotional competence.
A lack of social-emotional competence can lead to not only a decrease in a student’s connection with school, but also academic performance.
This reinforces the notion that social-emotional learning has a critical role to play in learning, as well as in school attendance, classroom behaviour, and academic engagement for all students.
The heavy focus on academic aspects of the curriculum and the demand for data-driven accountability that schools are required to address often result in the focus on social and emotional learning and mental health being overshadowed or pushed to one side.
Misinformation around inclusion
Inclusion is about being proactive in identifying the barriers learners encounter in attempting to access opportunities for quality education, and then removing those barriers.
It is about meeting the needs of all children to ensure they get a quality education and have the opportunity to reach their potential.
Often assumptions are made that “inclusion” means students need to be in mainstream classrooms at all times. When inclusion is interpreted in this way, students may be unable to access adjustments that adequately address and meet their needs.
The implementation of any adjustments need to be tailored to the students’ individual needs.
Schools also need to be careful not to run the risk of overgeneralising, as students with autism can be as different from each other as any other students.
Students on the spectrum often need time away from other students and the demands of the mainstream classroom. The frequency with which this needs to happen will be based on the individual needs of the students involved, and where they go in these situations would be dependent on the school setting.
Doing this would help them to not only manage the social and sensory challenges of the school environment, but also the stress and anxiety they can experience.
Schools also need to be careful not to run the risk of overgeneralising, as students with autism can be as different from each other as any other students..
Ideas for teachers
During the survey, students with autism made some suggestions as to how teachers could better support their needs.
They suggested that it would be useful if teachers could help them cope with change and transition by simply reminding them when a change was looming.
They also asked to use a tablet or laptop to help with school work, instead of handwriting. This can help students on the spectrum overcome many of the motor skill difficulties that make handwriting difficult.
Giving students a copy of instructions or information that their teacher writes on the board may also help.
Students with autism can find tasks requiring a lot of planning and organisation such as managing assignments, participating in assessments, navigating learning tasks, and completing homework extremely difficult.
This can have a negative impact on their cognitive, social and academic ability.
Schools could allow older students to take photos of these instructions using their mobile phone or tablet.
Having a quiet space to complete their assessments and getting assistance with organising themselves and the social aspects of school were also raised as important strategies.
How to better support students
There are a number of barriers to providing better and appropriate support to meet the educational needs of students with autism.
These include: funding, lack of knowledge and training, lack of specialist support staff and time, lack of appropriate resourcing and class sizes.
Funding can impact on the amount of resourcing, support and specialist staff available to teachers to help individualise their approach. Funding and resources vary from state to state and school to school.
Teacher training and experience in autism will vary.
In the Australian Autism Educational Needs Analysis, the majority of teachers (89%) and specialists (97.5%) who participated had received professional learning or specific training related to students on the autism spectrum.
Teachers and specialists working in the field need to feel adequately supported to meet the needs of these students, and this support must be ongoing.
The use of flexible and individually tailored educational approaches is crucial. This requires that teachers have an array of adjustments and resource options which can be implemented both in and outside of the classroom environment.
Input from a multidisciplinary team that includes educational specialists and allied health professionals should also be available.
It is not enough to give teachers professional development on autism. They need additional help from appropriate specialist staff to put adjustments in place that fit within the context of their classroom and school.
*Republished from original article*
Autism Spectrum Disorders (ASD) and Diet
Autism Spectrum Disorder, or ASD, is a complex developmental and neurological condition that typically appears during the first three years of life. It affects brain function, particularly in the areas of social interaction and communication skills. Classic symptoms include delayed talking, lack of interest in playing with other children, not wanting to be held or cuddled and poor eye contact. There is no known cause for ASD, but both genetics and environment are believed to play a role.
The Centers for Disease Control and Prevention estimates 1 in every 68 American children has been identified with ASD. It is about five times more common in boys than in girls.
People with ASD often repeat behaviors and have narrow, obsessive interests. These types of behavior can affect eating habits and food choices, which can lead to the following health concerns.
- Limited food selection or strong food dislikes. Someone with autism may be sensitive to the taste, smell, color and texture of foods. They may limit or totally avoid some foods and even whole food groups. Common dislikes include fruits, vegetables and slippery, soft foods.
- Not eating enough food. Kids with autism may have difficulty focusing on one task for an extended period of time. It may be hard for a child to sit down and eat a meal from start to finish.
- Constipation. This problem usually is caused by a child’s limited food choices. It typically can be remedied through a high-fiber diet, plenty of fluids and regular physical activity.
- Medication interactions. Some stimulant medications used with autism, such as Ritalin, lower appetite. This can reduce the amount of food a child eats, which can affect growth. Other medications may increase appetite or affect the absorption of certain vitamins and minerals. If your child takes medication, ask your healthcare provider about possible side effects.
Caring for a child with ASD can be challenging on many levels, and healthful eating is no exception. For children with ASD, a nutritious, balanced diet can make a world of difference in their ability to learn, how they manage their emotions and how they process information. Because children with ASD often have restricted diets as well as difficulty sitting through meal times, they may not be getting all the nutrients they need, particularly calcium and protein.
If you have a child with ASD, try these nutrition strategies.
Be Prepared for Pickiness
Many parents find their child’s sensitivity to tastes, colors, smells and textures the biggest barriers to a balanced diet. Getting your child to try new foods — especially those that are soft and slippery — may seem nearly impossible. You may find that your child avoids certain foods or even entire food groups. One of the easiest ways to approach sensory issues is to tackle them outside of the kitchen. Have your child visit the supermarket with you to choose a new food. When you get home, research it together on the Internet to learn about where it grows. Then, decide together how to prepare it. When you are done, don’t worry if your child doesn’t want to eat it. Simply becoming familiar with new foods in a low-pressure, positive way eventually can help your child become a more flexible eater.
For children with ASD, a nutritious, balanced diet can make a world of difference in their ability to learn, how they manage their emotions and how they process information..
Make Mealtimes Routine
A child with ASD will have to work harder at mealtimes because a busy kitchen, bright lights and even the way the furniture is arranged all are potential stressors. Making meals as predictable and routine as possible can help. Serving meals at the same time every day is one of the simplest ways to reduce stress. In addition, think about what concessions you can make for easier mealtimes. If your child is sensitive to lights, try dining by candlelight. Let your child pick a favorite food to include at every meal. Or, let your child choose a favorite seat at the table.
Seek Guidance for Special Diets
You may have heard that a gluten- or casein-free diet can improve symptoms of ASD. Gluten is a type of protein found in wheat, rye and barley. Casein is a protein found in milk. Proponents of the diet believe people with autism have a “leaky gut,” or intestine, which allows parts of gluten and casein to seep into the bloodstream and affect the brain and central nervous system. The belief is that this may lead to autism or magnify its symptoms. While some studies indicate that these diets may be effective for certain children, controlled scientific studies have not proven this to be true so more research is needed. Keep in mind that restrictive diets require careful planning to make sure your child’s nutrition needs are being met. Consult with a registered dietitian nutritionist before making any drastic changes to your child’s diet as there can be side effects and potential nutrient shortfalls when a gluten- or casein-free diet is self-prescribed.
Working With a Registered Dietitian Nutritionist
Most children, with or without autism, can be choosy and particular about the foods they eat. A registered dietitian nutritionist can identify any nutritional risks based on how your child eats, answer your questions about diet therapies and supplements advertised as helpful for autism and help guide your child on how to eat well and live healthfully.
*Republished from original article*