STATES RESPOND TO RISING RATES OF AUTISM
Volume 28, Issue 502 October 29, 2007
Megan Foreman and Matthew Gever
Since the 1990s, the number of children with autism spectrum disorder* (ASD) has increased steadily, catching the eyes of policymakers around the country. Lawmakers in 28 states passed autism-related legislation during their 2007 sessions.
Illinois passed a bill (SB 284) that will establish three group homes for adolescents with autism. “This legislation seeks to remedy the situation of lack of services for autistics aged 13 to 18, and offer some relief to their families as well,” said Representative Dennis Reboletti. The Department of Human Services will provide the funds needed to manage the centers, which will be staffed full-time by adults who specialize in treating children with autism.
Indiana enacted a law (HB 1428) that requires police officers directly employed by a school to undergo training to deal appropriately with autistic children. Children with this disability may not react as might be expected to many situations, especially stressful ones, and their behavior can be difficult to understand and manage. The law also allows local officials to close schools for up to three days in order to provide similar training for teachers. “Teachers and police officers will be equipped to recognize signs of these disorders, and will be better prepared to deal with an emergency situation should one arise,” said Representative Phil Hoy.
Last session, South Carolina and Oregon mandated that insurers cover autism spectrum disorders, making them the 17th and 18th states to mandate coverage. Legislators in the Palmetto State overrode the Governor’s veto to enact SB 20, which requires all insurers, including the state’s employee and retiree plans, to cover ASD treatment for anyone who was diagnosed before the age of eight. Oregon’s law (HB 2918) does not have the age requirement but otherwise has the same coverage mandate. A number of other states have created task forces to study the problem or have enacted resolutions promoting awareness of the disorders.
State Financing Options
States have employed a number of strategies to provide funds for therapies to help children with an ASD. No state has found a magic bullet, however, and many parents are left to piece together different funding streams to pay for the treatment their children’s needs.
Children with ASDs do not necessarily have medical needs that differ significantly from other children, but they can benefit from specialized treatments. For example, many children with an ASD can learn the rules of social communication when taught in an explicit fashion similar to foreign language instruction. Cognitive behavior therapies, such as learning a strategy to deal with unknown social situations, also have been known to help.
State Medicaid programs cover developmental assessments of children through their Early Periodic Screening, Diagnosis, and Treatment (EPSDT) programs. Some states pay for additional treatment under the Medicaid Home and Community-Based Services option. These programs include services, such as home health-care and case management, that allow people with special health-care needs to stay in their homes and communities.
Controversy about the Cause
Currently, there is no known cure for any autism spectrum disorder. And the exact cause of ASDs is unknown, although doctors believe there is a strong genetic component, as studies done with twins have shown a high correlation. Doctors also have linked the syndrome to structural abnormalities in the brain. Some have hypothesized that childhood vaccines can cause ASDs, specifically pointing to thimerosal, a mercury-based preservative once used in many childhood vaccines. As the number of vaccines required for children has risen, so have the rates of autism.
Others, however, question this link, pointing to scientific research which has found no connection between the two. The Centers for Disease Control and Prevention (CDC) has conducted a number of studies in the past few years on the mercury link and found no statistical association. Other organizations have echoed the CDC findings. “No scientific data link thimerosal used as a preservative in vaccines with any pediatric neurologic disorder, including autism,” said a statement from the American Association of Pediatrics.
Furthermore, in 1999, vaccine manufacturers removed thimerosal from 12 vaccines given to preschool age children as a precautionary measure. Only some flu vaccines given to children still contain any amount of thimerosal. Still, eight states (California, Delaware, Kansas, Illinois, Iowa, Missouri, New York and Washington) have laws that ban or limit the amount of mercury a vaccine can contain. “The possibility of mercury being dangerous to children is reason enough to take precautions as soon as possible,” said Missouri Senator Norma Champion when her bill to ban mercury was signed into law in 2005. A list of licensed vaccines and their thimerosal and mercury contents can be found at: http://www.vaccinesafety.edu/thi-table.htm
Some have argued that the rise in the number of autism cases is not really a rise at all, but rather a re-interpretation of diagnoses. For example, a study published last year in Pediatrics pointed out that the rise in ASD cases corresponded directly with a decrease in the cases of children with mental retardation or other learning disabilities. This implies that many children now labeled as autistic were previously considered to be retarded. “The growing administrative prevalence of autism from 1994 to 2003 was associated with corresponding declines in the usage of other diagnostic categories,” said the study’s authors.
*Autism is part of a group of developmental disabilities known as autism spectrum disorders (ASDs). ASDs include Asperger Syndrome, autism, Rett Syndrome, PDD NOS (Pervasive Developmental Disorder Not Otherwise Specified) and Childhood Disintegrative Disorder. Because these disabilities are on a spectrum, they can range from mild to debilitating, but all are characterized by impaired communication and social skills, and repetitive behaviors. Additional information is located at http://www.autismspeaks.org/whatisit/index.php
For more information on autism and legislation related to it, please contact Megan Foreman at megan.foreman@ncsl.org, (303) 856-1401.
© Copyright 2007, State Health Notes
|
