Archive for October 2010

Low Functioning Autism Reality and Autism Posers at New York Magazine


New York Magazine Says Aspergians and High Functioning Autistics, like 
Ari and Alex Shown Posing for their NY Magazine Coronations,   who Socialize
with Washington Pols and NY Media, Drive Land Rovers, Produce  Videos
with Autism Speaks; and Argue with Experts at IACC  Meetings 
Represent, and Speak for, People with Autism

Many parents and siblings of persons with low functioning autism might  disagree

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I received the following email from Wanda James in the Upper Ottawa Valley and post  it with her consent. It is important for those who have children and siblings who are severely affected by autism disorder to speak out and be heard.


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"Hello

I'm so glad to have found you if only because I've been searching the web endlessly and just about ready to pull my hair out reading about all these high-functioning socially inhibited "disabled" people. It was a relief to find someone who understands the true nature of autism and what it entails.

I'm desperately trying to find some info for my mother who is caring for my severely autistic 39 year-old sister. My parents are elderly now and have no idea what will happen to Jennifer when they go. No one in the immediate family can take her-- she is very hard to handle- very self-destructive and obsessive to the point of violence if the ritual is disrupted.  I've been searching for anything to give them hope that there is something out there but I can't find anything except a lot of people who are rejecting help because they don't want autism to be seen as a disadvantage. Makes me so mad. I joined a forum just to "let them have it" but I guess I ran out of steam.  I've got to choose my battles carefully these days. My parents are a bit isolated on a farm in the upper Ottawa Valley in Eastern Ontario so there's not much of a network there. I just wanted to be able to give them some hope that there are programs out there. Except there aren't any. Autism Ontario and the Autistic Society seem to be lobbying the government for lower priority things, like camps for kids, publications, workshops, theatre groups, raising awareness etc.-- and nothing for actual bricks and mortar housing or the staff to put in them. They closed down the only place we had here in Ontario for severely disabled people because they deemed it too "institutional" and not efficient. They then went on to open some prototype group homes which all failed because the people living in them weren't as independent as the government assumed they'd be. Why are governments usually made up of idealistic morons? Don't get me started! : )

I'd like to know how you are doing with getting the message through to governments, etc. I would be lobbying on the Hill if I could, but I'm disabled myself with pretty severe rheumatoid arthritis. I share the sense of fear my parents have and there don't seem to be any answers. Meanwhile, autism has become a trendy thing to have-- and suddenly everybody has it if they so much as stare into space for 5 seconds. I could not believe some of the forums. One woman said she was okay in social situations, but nervous in interviews! Well, duh. Who isn't? But the danger here is the "watering down" of the impact of autism on a person's (and) family's) life. It clogs up the system, driving the numbers up which governments take into account when they are doling out assistance. In the end, the people who really need the help, don't get it. It's much the same with arthritis. Everybody I meet has it-- in a thumb, wrist, whatever. They take a Tylenol and they're fine. But I will be having chemo next month to help eradicate mine. I've got 3 artificial joints and tendon repairs. I've been on some pretty life-threatening medications. But it's hard to be taken seriously, because "hey, my aunt has arthritis, and she can still work". That's why I wrote the book Getting Up is Hard to Do: Life with Rheumatoid Arthritis- to try to get the message out there. Now I've got to fight for my sister. I don't know how to deal with this.

Hope you don't mind me writing.

Take care

Wanda James
Ottawa

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If you have read this blog on occasion you will know that I try to being attention to those who are typically ignored by the mainstream media that fawns over such "autistic" persons as Ari Ne'eman, John Elder Robison, Alex Plank and Amanda Baggs ... all people of considerable intellect and high functioning abilities,  people whose "autism" has little if anything in common with my  severely autistic son diagnosed with autistic disorder by three pediatricians with autism expertise and assessed by an autism specialized clinical psychologist and professor emeritus.  Those for whom autism is a "social" disorder, a different way of thinking or a "culture" do not face the autism reality faced by my son.

Occasionally I hear from parents or other persons with a loved one with  low functioning autism who face challenges similar to my son.  Like me they are all too aware of the periodic Big Media (CNN, CBC, NYT, Newsweek, New York Magazine etc)  anointment of "new" voices of "autism", of new "leaders" of autism.  Where did Ari Ne'eman come from before the New York Magazine elected him as the "autism self advocate" par excellence? How did IACC, Interagency Autism Co-ordinating Committee, member Ne'eman, diagnosed as a teen with Aspergers, a university student with the social skills to hob nob with US federal and state politicians and make innumerable media appearances, acquire the knowledge and understanding of severe autistic disorders to be able to speak on behalf of people like my son?

Various autism advocacy organizations, including Autism Speaks, have accepted these high functioning, barely autistic, persons as spokespersons for all on the autism spectrum and virtually ignore the realities of those most severely affected by autism. As with media and advocacy groups so too with governments which tend to ignore the most severely affected by autism, the low functioning autistic persons who live out their lives in restricted, archaic mental institutions instead of creating  positive, modernized, secure residential facilities staffed with autism trained personnel and access to badly needed professional. For many governments John Elder Robinson, former rock band musician, successful businessman, author and family man is the face of autism not Bryan Nevins who was left to  swelter to death, unable to remove himself from a hot van in Pennsylvania.  For many governments the face of autism is a high functioning, intelligent and articulate media star not the 50 year old autistic woman who could not speak or convey emotions or pain and who was repeatedly battered and beaten by employees at the PLUS Group Home Inc. residential care facility in Long Island. 

Other parents, and members of families with severely autistic loved ones, know the difference. They know that their children are ignored by media, "autism" advocacy groups, governments, even by the American Psychiatric Association which reduced the percentage of persons with autism AND intellectual disability by expanding the definition of autism disorders in the DSM-IV to include high functioning persons with no intellectual disability.  Meanwhile, the APA is continuing its efforts to ignore and exclude those with low functioning autism disorders by further expanding, and diluting,  the definition of autism in the DSM-5.

 The New York magazine is unlikely to visit  any time soon some of the institutions  and facilities like those I have visited or the one in Long Island where a 50 year old autistic woman was abused or the one in Pennsylvania where a young severely autistic man died a horrific death in a searing hot van.  In all fairness though it could be difficult to get some of autistic residents in those facilities to pose  elegantly for some "glam" shots for the New York Magazine.


Those of us with children, siblings and loved ones  severely affected by Autism disorders must continue the fight to better their lives in the face of media, advocacy group and government indifference. 
We have no choice.  Our severely autistic loved ones have no alternative.

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Manslaughter Charged in Hot Van Death of 20 Year Old Man with Severe Autism

Stacey Strauss of Philadelphia has been charged with manslaughter in the death of  Bryan Nevins, a 20 year old man with severe autism, who was allegedly left  in her care the day he was left to die in a sweltering hot van.  As reported by Jo Ciavaglia, Bucks County Courier Times, the court heard horrific testimony about  Nevin's death, including the fact that when  Bryan  Nevins was  pulled out of the locked van, hours after it had returned to the Woods Service facility,  his skin started slipping off his body. 

Ms Strauss has been charged, not convicted,  and if the matter proceeds to trial, she will do so with a presumption of innocence and with the burden on the state of proving her guilt beyond a reasonable doubt. The arguments at the preliminary hearing  indicate that her legal counsel will argue that Nevins' death was a horrific accident that resulted from a "system wide" failure and that the blame goes beyond his client.

A court in Pennsylvania will decide whether Stacey Strauss is guilty as charged and this Canadian lawyer will not presume to know what that court will decide. Legal issues aside though this father of a 14 year old boy with severe autism who knows that some day, some one, or some persons, will be responsible for caring for my son, hopes with all my heart that they  provide much, much, better care than Bryan Nevins received.

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Association for Science in Autism Treatment: New Brunswick (Canada) is Already a Leader in Autism Treatment

During the recent election campaign CBC published on its web site an article by New Brunswick autism expert Dr. Paul McDonnell. The CBC headline read N.B. Can Be a Leader in Autism Services" and the article appeared on September 14 2010.   David Celiberti BCBA-D, President Association for Science in Autism Treatment, commented on that article pointing out that New Brunswick is already a leader in autism services. Dr. Celiberti is very familiar with New Brunswick's autism service delivery, having spoken in Fredericton and having met with parents, autism advocates and autism professionals here.  His comments on the CBC article can be found on the ASAT website under the title ASAT Responds to Canadian CBC's "N.B. Can Be a Leader in Autism Services" and are set out following this introduction. (The bold blue emphasis is added by me - HLD)
ASAT's recognition and encouragement to continue in our efforts here in New Brunswick are most welcome.

"ASAT Responds to Canadian CBC's "N.B. Can Be a Leader in Autism Services"

Saturday, October 23, 2010

I read with great interest your recent article about the state of services in New Brunswick (“N.B. Can Be a Leader in Autism Services," September 14, 2010). I do beg to differ about the title of the piece. New Brunswick is already a leader. To have amassed 800 trained agents of change in six years is nothing short of incredible and inspiring, particularly given the diversity of your province with respect to geography and language. Other Canadian provinces can look to New Brunswick for an exemplary model of how things could and should be for children with autism and their families.

There is a misconception that services in the United States are superior to that of our neighbors to the north. I can assure you that children with autism in rural areas and in economically depressed areas of the U.S. do not always access state of the art, science-based treatment such as those based on applied behavior analysis. In many cases throughout the US, children with autism receive poor quality behavior analytic services that may be lessened if providers were able to access more intensive training and networking opportunities similar to what is being offered in your province. Part of the Association for Science in Autism Treatment (ASAT)'s mission is to help close that gap through information dissemination, and we are keenly interested in the efforts of leaders like yourself developing, implementing, and evaluating systems.

And like other true leaders, you have looked critically at your accomplishments with an eye toward making every year of service delivery better than the previous year. We applaud your recognition that treatment parameters such as intensity need to be tailored to each child to maximize gains. When resources are scarce, this individualization can be an arduous task, but nonetheless critically important. Equally important is the need to communicate to government officials, tax payers and other stakeholders that immense financial savings are attached to doing right by our children when they are young.

It is unfortunate that funding for parent training is not more abundant. Optimal outcomes for children with autism are predicated on the support of educated, informed and skillful parents. Promoting carryover, ensuring consistency, and enhancing skill development across all environments are crucial roles for parents, but parents require support and training to assume these crucial roles. Your stated concerns and insights about the dearth of services for adults are much appreciated, and reflect the challenges that we have here in the U.S as well.

Families of children with autism in New Brunswick are blessed. Keep fighting the good fight.

David Celiberti, Ph.D., BCBA-D, President
Association for Science in Autism Treatment

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What Autism Spectrum Disorder Severity Criteria Are Being Evaluated In The DSM-5 Clinical Field Trials?

Deborah Brauser, in an article on the Medscape Today website, advises that the APA has begun field trials for the DSM-5 diagnostic critieria including severity criteria which makes the APA's failure to disclose the proposed severity criteria curious, at least to this interested father of a 14 year old,  with an Autistic Disorder (DSM-IV) diagnosis and assessed with profound developmental delays:
October 19, 2010 — The American Psychiatric Association (APA) has announced that standardized field trials have now started in preparation for the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). .... Severity measures, through the use of questionnaires and other tools to help assess patient symptom severity on a rating scale, will also be examined during the field trials, as will "cross-cutting dimensional measures." These are tools for "assessing symptoms that occur across a wide range of diagnoses, such as anxiety or sleep problems." 
Severity criteria are being examined in the field trials which are already underway? If  so, if severity criteria for the New Autism Spectrum Disorder, Autistic Disorder in the DSM-5, are already established,  then why are they still not mentioned on the DSM-5 web site which tells interested persons to check back for updates on the subject?

Some disorders do have severity criteria posted on the DSM-5 web site:

Bipolar II Disorder
Personality Disorder Types
Attenuated Psychotic Symptoms Syndrome

Not all of the disorders, existing, newly proposed disorders or reclassified disorders have severity criteria published on the DSM-5 site. Presumably different work groups for the DSM-5 have reported in with their proposed criteria at different times but the fact that the severity criteria are being assessed in the field trials has to mean that each of the proposed disorders have in fact had the associated severity criteria established.  An article published in the American Journal of Psychiatry, Moving Toward DSM-5: The Field Trials,confirms that the clinical field trials will include evaluation of the related severity criteria for each disorder being studied, including autism:


"Formal field trials will involve the testing of between two and five specific diagnoses at any one site. The diagnoses tested at a site will depend on their relative frequency there. For example, major depressive disorder and complex somatic symptom disorder can be evaluated at a general medical clinic, but autism spectrum disorders require evaluation in a specialty psychiatric clinic specializing in these disorders.  ...... At each site, a research coordinator, trained and monitored centrally, will record each successive entry to the clinic over a specific time period to provide necessary sampling weights for that site's variance in reliability and validity. DSM-IV diagnoses obtained for clinical purposes at each site will be used to place each consenting patient into either a stratum likely to be rich in a target diagnosis at that clinic or a stratum consisting of a random sample of all other diagnoses. The goal is to recruit 50 patients per stratum per site, a total of 150 to 300 patients for each diagnosis under evaluation, to have adequate power for a site-specific determination of precision. Two DSM-5-trained clinicians who are new to the patient will be assigned to conduct independent clinical interviews of the same patient at least 4 hours, but not more than 2 weeks, apart. The attending clinician will be able to observe the interviews. The interviewing clinicians will know the target diagnoses at that site but will be blinded to the stratum to which each patient is assigned and to the attending clinician's diagnosis. The interviewing clinician at each session will be provided the patient's current crosscutting assessments, conduct a clinical interview with the patient, make one or more categorical diagnoses using DSM-5 criteria, and complete associated dimensional severity ratings.   [bold and underline emphases added]

The Autism Spectrum Disorder(s), including their severity criteria, are being evaluated at  clinical field trials now under way and yet the severity criteria are not posted despite entreaties by the DSM-5 to check back for updates under that category.  It would seem reasonable to speculate that their are reasons for this failure and that those reasons relate to the feedback received, much of it from persons who objected to Aspergers being grouped together with Autistic Disorder, with its high number of persons who are also Intellectually Disabled.

Any speculation about motives for the failure to disclose the autism spectrum disorder severity criteria is exactly that .... speculation. Unfortunately the APA has provided no  real information for the public to consider as clinical field trials are underway which could impact the lives of many persons with Autism Disorders, including the 75-80% who have  allegedly "co-morbid" intellectual disabilities.  The public, in the midst of such an important process, a process trumpeted wide and far for its transparency and public participation,  is simply left to speculate.

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Saskatchewan, Canada's Autism Wasteland, Is Exhibit 1 in the Case for a National Autism Strategy

More than three years after I described Saskatchewan as Canada's Autism Wasteland the label still accurately describes the state of autism services in the prairie province according to a FEAT opinion article in the Star-Phoenix

The Families for Effective Autism Treatment article argues that some money has been spent but it has been spent ineffectively and cautions anyone with an autistic child not to move to the "Land of the Living Skies" as Saskatchewan markets itself:

It sounds impressive when you hear about all the money being put into autism and programs the government is running, but ask families across Saskatchewan about how well this money is being spent. Ask our government for current and regular report cards. Ask what successes it has accomplished with these new programs and positions. Ask it to provide statistics on how many individuals receive adequate and professionally trained support.

Ultimately, individuals with autism continue to lose.

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Our children do not have time to waste while valuable dollars are spent creating expensive, ineffective services that aren't based on evidence and research. Our children need the help of proven therapies before they become another sad statistic lost in Autism's Wasteland.

Let your voice be heard for those who cannot. Saskatchewan can't afford to keep spending millions of dollars for ineffective programs that do not help individuals with autism. Let's use the money wisely and try not to re-create the wheel.

SASKFEAT is demanding immediate individualized funding, which is not income tested, until an acceptable and proven autism strategy is in place in Saskatchewan -- a strategy that addresses the lifetime needs of all individuals with ASD, and that is delivered across this province. Our families have been waiting and suffering long enough.

3 years after Saskatchewan started to fund autism services they still do not have an effective autism strategy in place. It is the autistic children of Saskatchewan who lost their 3 years of development potential, particularly during their early years between 2 and 5, who will have lost the most and who will pay the price for government and bureaucratic nonchalance or incompetence. 

Saskatchewan, Canada's Autism Wasteland, is also Exhibit 1 in the case for a National Autism Strategy.

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Autism Services in New Brunswick 2010 Update

I would like to thank Fredericton's Daily Gleaner for publishing my letter to the editor concerning the state of autism services in Canada, and more specifically in New Brunswick, in October 2010.


Many do not know that Autism Awareness Month is recognized in October in Canada not April as in the US.


I have been blogging about autism issues for four years and it is easy enough to publish my own comments on this humble blog. It is a big boost though when the assistance, and reach, of a long established local paper is provided.


As stated in the Daily Gleaner today:



Adults with autism need help


Re: Autism


October is Autism Awareness Month in Canada.


Autism is a disorder which is diagnosed based on communication, social and behavioral challenges.


Approximately 75-80 per cent of persons with the most severe form of autism, Autistic Disorder, also have intellectual disabilities.


When my son was diagnosed with Autistic Disorder 12 years ago, the Center for Disease Control in the U.S. estimated that 1 in 500 persons had an autism disorder. Today that CDC estimate has risen to 1 in 110.


Many autistic children and adults can't function on a level which would permit them to live independent lives.


Despite these realities, our federal government has done nothing to deal with Canada's growing autism crisis, preferring to leave autism as a provincial responsibility.


Across Canada provincial governments have provided varying levels of responses. Fortunately for my son, New Brunswick has actually been a leader in developing early intervention and school services for autistic children.


The government-funded early intervention services, provided by competent trained staff at the autism intervention centres, makes New Brunswick a leader in that area.


The UNB-CEL Autism Intervention Training Program, which has received high marks by the most expert professionals on external review, has provided training to staff at the early intervention centres and to approximately 500 teacher assistants and resource teachers in New Brunswick schools.


Severely challenged autistic children like my son are able to receive instruction in quieter environments within neighborhood schools, while visiting common areas of the schools like gyms, pools and kitchens for socializing purposes.


As a long time advocate for these evidence-based services for autistic children I thank former premiers Bernard Lord and Shawn Graham for their rich contributions to New Brunswick's autistic preschoolers and students.
And I thank the many parents who fought so hard to draw attention to the need for these services.


I also thank professionals who have led the way like Dr. Paul McDonnell, Dr. Annie Murphy, Dr. Tara Kennedy, all the directors and staff of the autism intervention centers and Ann Higgins of the UNB-CEL Autism Intervention Training Program.


We have all failed, however, to improve the living conditions of autistic youth and adults, some of whom live in desperate conditions on hospital wards, with over-challenged and increasingly elderly parents and in psychiatric hospitals.


Autistic adults, as Professor Emeritus Paul McDonnell has recently stated, are badly in need of a modernized residential care and treatment system. We must act now to help autistic adults in New Brunswick.


Harold L. Doherty
Fredericton

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