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CDC Estimates 1 in 50 Children in United States Has Been Identified as Having an Autism Spectrum Disorder - New York Times - March 20, 2013

Parental Study Shows Rise in Autism Spectrum Cases

The likelihood of a school-aged American child receiving a diagnosis of autism, Asperger syndrome or a related developmental disorder increased 72 percent in 2011-12 from 2007, according to an analysis of a phone survey of parents released Wednesday by the Centers for Disease Control and Prevention and the Health Resources and Services Administration.

According to experts not involved in the report, the increase coincided with a period of soaring awareness of autism spectrum disorders among clinicians and schools, as well as parents.

The report emphasized that while the numbers changed from 1 in 86 children, ages 6 to 17, having received a diagnosis in a 2007 parent survey, to 1 in 50 children in the current report, most of the increase was because of previously undiagnosed cases.

"Our findings suggest that the increase in prevalence is due to improved recognition of autism spectrum disorders," said Stephen J. Blumberg, a senior scientist with the centers' National Center for Health Statistics and the lead author of the study, "as opposed to children with newly developed risks for them."

Parents in the newer survey who reported that their children had received a diagnosis between 2008 and 2012 were far more likely to report that the diagnosis had been characterized as "mild" than parents who received the diagnosis earlier.

"We in the field don't have a standard set of definitions about what is mild and severe yet," said Dr. Susan L. Hyman, a professor of pediatrics at the University of Rochester Medical Center. "Yet this survey allows parents to determine whether they see their child as mild or severe."

In keeping with earlier studies about autism spectrum disorders, the new report reflected gender disparities. In the new study, 1 in 31 boys had received a diagnosis, up from 1 in 56 boys in 2007. By contrast, 1 in 143 girls received a diagnosis, according to the latest report; in 2007, 1 in 204 girls received a diagnosis.


Autism Prevalence Is Now At 1 In 50 Children - FORBES.COM - March 20, 2013

Pharma & Healhcare pages

The US Centers for Disease Control and Prevention (CDC) has released new figures for autism prevalence in the United States. They now give a prevalence of 1 in 50, but this story, like most autism-related stories, goes deeper than the numbers. First, this prevalence estimate doesn't focus only on 8-year-olds, the population used for deriving the 1 in 88 number reported in 2012. Instead, it encompasses the number of diagnosed autistic people walking around in 2011 and 2012 who were ages 6 to 17. The 2007 percentage of the population fitting that description was 1.16%. These new numbers put that value for 2011-2012 at 2%. From the CDC's report [PDF]:

"The magnitude of the increase was greatest for boys and for adolescents aged 14-17. Cohort analyses revealed consistent estimates of both the prevalence of parent-reported ASD (autism spectrum disorder) and autism severity ratings over time. Children who were first diagnosed in or after 2008 accounted for much of the observed prevalence increase among school-aged children (those aged 6-17). School-aged children diagnosed in or after 2008 were more likely to have milder ASD and less likely to have severe ASD than those diagnosed in or before 2007."

According to the CDC, hidden within these numbers is the finding that most of the increase from 2007 to now occurred in school-aged children. In other words, given that it's possible to diagnose autism as early as age 18 months and usually by age 5, many of these new autism diagnoses were in children who received them relatively later. Children who were, therefore, walking around for quite a few years with autism that went unrecognized and uncounted. That fits with the idea that a lot of the increase in autism we've seen in the last decade has much to do with greater awareness and identification.

The CDC's information comes from parent reports, acquired by random telephone surveys. Parents answered questions about the ASD diagnosis and severity, and the age and year the child was diagnosed. When the CDC did this study in 2007, the results relied on information for 63,967 children; for 2011-2012, that number was slightly higher at 65,556.

From 2007 to 2013, parent-reported autism prevalence increased significantly in all age groups in the 6-17 range and increased for boys from 1.8% to 3.23%. Girls also showed an increase, but not as dramatic, from 0.49% to 0.70%. Autism among children ages 14 to 17 was up more than 1%, compared to children in the youngest, 6 to 9 age group (0.5%). In 2007, this older group, born in the 1990s, was less likely to have ASD than younger children.

Autism severity ratings (or, as a friend of mine analogizes, octane rating) also was revealing. Children ages 2 to 13 in 2007 and diagnosed by that year - and who were thus 6 to 17 in 2011-2012 - showed no changes in ASD severity across years. However, children in the 6 to 17 bracket who were diagnosed after 2007 were more likely to be rated as having "mild" ASD (6.9% for 2011-2012 versus 16.9% for 2007), suggesting that greater awareness and diagnostic capture explain the ASD increase in this group.

The CDC authors observe that the 14% of children ages 14 to 17 who were diagnosed at age 7 or later received their diagnosis "well beyond" the time when autism signs and symptoms become clear. In addition, more than half these children were classified as having "mild" ASD, according to their parents. The CDC authors say,

"Together, these findings suggest that the increase in prevalence of parent-reported ASD may have resulted from improved ascertainment of ASD by doctors and other health care professionals in recent years, especially when the symptoms are mild. Changes in the ascertainment of ASD could occur because of changes in ASD awareness among parents or health care professionals, increased access to diagnostic services, changes in how screening tests or diagnostic criteria are used, or increased special education placements in the community. "

The report concludes:

"Increases in the prevalence of parent-reported ASD continued through 2011-2012, and much of the recent increase-especially for children aged 6-13-was the result of diagnoses of children with previously unrecognized ASD."

You will probably see a lot of headlines about the 1 in 50. Some organizations might even try to use those numbers to scare people, to talk about an "epidemic" or a "tsunami." But if you look at the numbers and the report itself, you'll see that overall, the numbers of people born with autism aren't necessarily increasing dramatically. It's just that we're getting better and better at counting them. The next step is getting better at accepting autistic people, seeing their potential, and ensuring the supports and resources they need to fulfill that potential.


CDC Estimates 1 in 88 Children in United States Has Been Identified as Having an Autism Spectrum Disorder - March 2012

CDC Data Help Communities Better Serve These Children

The Centers for Disease Control and Prevention estimates that 1 in 88 children in the United States has been identified as having an autism spectrum disorder (ASD), according to a new study released today that looked at data from 14 communities.  Autism spectrum disorders are almost five times more common among boys than girls – with 1 in 54 boys identified.

The number of children identified with ASDs ranged from 1 in 210 children in Alabama to 1 in 47 children in Utah.  The largest increases were among Hispanic and black children.

The report, Prevalence of Autism Spectrum Disorders – Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008, provides autism prevalence estimates from 14 areas. It was published today in the Morbidity and Mortality Weekly Report.

“This information paints a picture of the magnitude of the condition across our country and helps us understand how communities identify children with autism,” said Health and Human Services (HHS) Secretary Kathleen Sebelius.  “That is why HHS and our entire administration has been working hard to improve the lives of people living with autism spectrum disorders and their families by improving research, support, and services.”

“One thing the data tells us with certainty – there are more children and families that need help,” said CDC Director Thomas Frieden, M.D., M.P.H. “We must continue to track autism spectrum disorders because this is the information communities need to guide improvements in services to help children.”

The results of CDC’s study highlight the importance of the Obama administration’s efforts to address the needs of people with ASDs, including the work of the Interagency Autism Coordinating Committee (IACC) at the U.S. Department of Health and Human Services. The IACC’s charge is to facilitate ASD research, screening, intervention, and education.  As part of this effort, the National Institutes of Health has invested in research to identify possible risk factors and effective therapies for people with ASDs.

Study results from the 2008 surveillance year show 11.3 per 1,000 8-year-old children have been identified as having an ASD.  This marks a 23 percent increase since the last report in 2009.  Some of this increase is due to the way children are identified, diagnosed and served in their communities, although exactly how much is due to these factors is unknown.  “To understand more, we need to keep accelerating our research into risk factors and causes of autism spectrum disorders,” said Coleen Boyle, Ph.D., M.S.Hyg., director of CDC’s National Center on Birth Defects and Developmental Disabilities.

The study also shows more children are being diagnosed by age 3, an increase from 12 percent for children born in 1994 to 18 percent for children born in 2000. “Unfortunately, 40 percent of the children in this study aren’t getting a diagnosis until after age 4. We are working hard to change that,” said Boyle.

The most important thing for parents to do is to act quickly whenever there is a concern about a child’s development. 

  1. Talk to your child’s doctor about your concerns.
  2. Call your local early intervention program or school system for an assessment. 
  3. Remember you do not need a diagnosis to access services for your child.

To learn more about this study, visit www.cdc.gov/autism
For information on CDC’s tools to help families track their child’s development, visit www.cdc.gov/actearly
To learn more about the research CDC is doing on autism, visit www.cdc.gov/ncbddd/autism/research.html
To learn more about the Administration’s commitment to combating autism, visit http://www.hhs.gov/autism/factsheet_autism_support.html.

U.S. Department of Health and Human Services

CDC works 24/7 saving lives, protecting people from health threats, and saving money to have a more secure nation.  Whether these threats are chronic or acute, manmade or natural, human error or deliberate attack, global or domestic, CDC is the U.S. health protection agency.


• Historical Document: March 29, 2012
Content source: Office of the Associate Director for Communication, Division of News and Electronic Media
CDC Division of News & Electronic Media • (404) 639-3286

A Full Life with Autism for 1 in 88 Children in the U.S.
Posted: 04/ 2/2012 11:04 AM

Description: Chantal Sicile-Kira
Chantal Sicile-Kira
Author, A Full Life With Autism, Founder of www.AutismCollege.com

New figures have just been released by The Center for Disease Control and Prevention (CDC) just in time for Autism Awareness month: 1 in 88 children and one in 54 boys in the U.S. has an autism spectrum disorder. We'll be hearing about the need for services for the newly diagnosed, and they will need help.

But let's not forget about the 700,000 to 800,000 teens and young adults who will be leaving the school system in the next few years. Our society is not prepared for the sociological or economic impact of this, and the transition to adulthood is particularly hard for those with autism and their families as they exit mandated school services for real life as adults.

My son Jeremy recently exited school services and the transition to adult services is no picnic. As a parent, I didn't expect that everything would be handed to my disabled son on a silver platter, so we had done our homework and we had plans. Yet like real life, nothing goes as smoothly as you would like. It's the same story for all families. So Jeremy and I decided to write a book about it, each from our own perspective: A Full Life with Autism: From Learning to Forming Relationships to Achieving Independence.

Jeremy is severely impacted by autism, yet graduated from high school at the age of 22 with a GPA of 3.78, and gave a commencement speech using voice output technology. But he still requires 24-hour support. And he is not the only one.

The perspective of those on the spectrum is very important, which is why I'm happy my son is willing to share his experiences and point of view to help others. That's also why I've invited Temple Grandin, Ph.D. (subject of the Emmy-award winning HBO movie, Temple Grandin to answer questions from listeners on-line at AutismCollege.com on April 7th.

Here's what Temple, a professor at Colorado State University, bestselling author, consultant to the livestock industry on animal behavior and a very successful person with high-functioning autism has to say about preparing for adult life:

One of the most difficult times for many individuals on the spectrum is making the transition into adulthood. This is an area that is sadly neglected despite the fact that it is hugely important. I have had teachers and parents tell me many sad stories where a young adult loses a job or drops out of college because they were not prepared for a world away from home.

To write an informative book, Jeremy and I did the research on existing services and interviewed people to find out what innovative plans they had. It was empowering to hear all that families and organizations are working on, even if it is not enough. Variety in options is crucial. Change in the systems is necessary as well. As Jeremy puts it in the preface of A Full Life With Autism:

All of us on the spectrum are different from one another and our wants and hopes are as well. It is important to recognize that when planning our lives. Mighty systems are in place that don't understand this. Our nation was built on the principle that all people are created equally. Yet all Americans are not treated equally. African-Americans, women, gay people and the disabled continue to struggle, even those that have been given equal rights. Systems change will not happen unless we convince society that we are all differently abled yet deserve equal consideration.

So what are parents and their loved one supposed to do to prepare for adult life? The first step is to get educated about how to best prepare your loved one or your student. You can ask Temple Grandin on April 7th, and you can read what Jeremy has to say in the book. We know how hard it is for parents and for those on the spectrum. We want people to know the realities, but we want to empower them with the possibilities -- because everyone deserves a full life.

80% Autism Divorce Rate Debunked – Health News
Published: May 22, 2010 at 1:27 AM
http://www.upi.com/

BALTIMORE, May 22 (UPI) -- An 80 percent divorce rate among parents of children with autism is often cited, but a U.S. study debunks this high divorce rate, researchers said.

Lead author Brian Freedman, clinical director of the Center for Autism and Related Disorders at Kennedy Krieger Institute, said his study debunks misunderstanding about high divorce rates among parents of children with autism.

Freedman and his team found that 64 percent of children with an autism spectrum disorder have two married biological or adoptive parents, while 65 percent of children who do not have an autism spectrum disorder had two parents.

"In the work I've done with children with autism, I've come across many couples who quote this 80 percent divorce rate to me," Freedman said in a statement.

"They don't know what the future holds for their child, and feel a sense of hopelessness about the future of their marriage as well -- almost like getting a diagnosis of autism and a diagnosis of divorce at the same time."

The researchers used data from the 2007 National Survey of Children's Health, a nationally representative sample of 77,911 children ages 3-17.

Freedman noted past research found couples with a child with autism experience more marital stress than parents of typically developing children or parents of children with Down syndrome.


© 2010 United Press International, Inc. All Rights Reserved. Any reproduction, republication, redistribution and/or modification of any UPI content is expressly prohibited without UPI's prior written consent.

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Autism Families: High Divorce Rate Is a Myth
Study Shows Divorce Rates Are Similar for Parents With and
Without Autistic Children

By Kathleen Doheny
WebMD Health News
Reviewed by Laura J. Martin, MD

May 19, 2010 -- Parents of autistic children often hear that the divorce rate in families with autism is 80%, but a new study debunks that figure as a myth.

''There really weren't any significant differences in terms of family structure when you consider children with autism and those without," says study researcher Brian Freedman, PhD, clinical director of the Center for Autism and Related Disorders at the Kennedy Krieger Institute in Baltimore.

''In fact what we found is that children with autism remained with both biological or adoptive parents 64% of the time, compared with children in families without autism, who remained [with both biological or adoptive parents] 65% of the time," Freedman tells WebMD.

''That debunks the myth of an 80% divorce rate," Freedman says. An 80% rate is roughly double the U.S. divorce rate for first marriages.

Freedman is due to present his findings Friday at the International Meeting for Autism Research in Philadelphia. About one in 110 children in the U.S. has autism spectrum disorder (ASD), a group of neurodevelopmental disorders that include autism as well as Asperger's syndrome and other forms that involve difficulties in social relationships and communication.

The new finding, Freeman says, will hopefully relieve some of the stress parents of children with autism feel. Families he has counseled often tell him they feel they have gotten two diagnoses at once: a child with autism and a prediction of divorce, when they hear the oft-quoted figure of 80%.

''They talk about how disheartening that is, and how their relationship seems doomed," he tells WebMD.

While the figure of an 80% split-up rate among parents of children with autism is often talked about, Freedman says he searched for the original study and never found one.  It may have originated from pure speculation and then was brought up again and again, with no solid evidence.

''Certainly studies of parents of children with autism talk about the extra stress," he says, so perhaps the leap was made that the stress led to an unusually high rate of divorce.

Structure of Families With Autism

Freedman examined data from the 2007 National Survey of Children's Health, including a nationally representative sample of 77,911 children, ages 3 to 17.

He looked at whether the family structure was a two-parent household, with either biological or adoptive married partners, or was not traditional, such as a two-parent household including a stepparent, a household headed by a single parent, or other structures.

The percent of children with ASD living in a two-parent biological or adoptive household was close to the percent of children without ASD in such a family structure -- 64% vs. 65%.

That percent held even when the researchers took into account other factors that could have affected family structure, such as socioeconomic status or demographics.

No Evidence to Link Vaccines

Description: David Kirby
David Kirby
Author/Journalist
Posted: February 25, 2008 12:42 PM

Government Concedes Vaccine-Autism Case in Federal Court - Now What?

After years of insisting there is no evidence to link vaccines with the onset of autism spectrum disorder (ASD), the US government has quietly conceded a vaccine-autism case in the Court of Federal Claims.

The unprecedented concession was filed on November 9, and sealed to protect the plaintiff's identify. It was obtained through individuals unrelated to the case.

The claim, one of 4,900 autism cases currently pending in Federal "Vaccine Court," was conceded by US Assistant Attorney General Peter Keisler and other Justice Department officials, on behalf of the Department of Health and Human Services, the "defendant" in all Vaccine Court cases.

The child's claim against the government -- that mercury-containing vaccines were the cause of her autism -- was supposed to be one of three "test cases" for the thimerosal-autism theory currently under consideration by a three-member panel of Special Masters, the presiding justices in Federal Claims Court.

Keisler wrote that medical personnel at the HHS Division of Vaccine Injury Compensation (DVIC) had reviewed the case and "concluded that compensation is appropriate."

The doctors conceded that the child was healthy and developing normally until her 18-month well-baby visit, when she received vaccinations against nine different diseases all at once (two contained thimerosal).

Days later, the girl began spiraling downward into a cascade of illnesses and setbacks that, within months, presented as symptoms of autism, including: No response to verbal direction; loss of language skills; no eye contact; loss of "relatedness;" insomnia; incessant screaming; arching; and "watching the florescent lights repeatedly during examination."

Seven months after vaccination, the patient was diagnosed by Dr. Andrew Zimmerman, a leading neurologist at the Kennedy Krieger Children's Hospital Neurology Clinic, with "regressive encephalopathy (brain disease) with features consistent with autistic spectrum disorder, following normal development." The girl also met the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) official criteria for autism.

In its written concession, the government said the child had a pre-existing mitochondrial disorder that was "aggravated" by her shots, and which ultimately resulted in an ASD diagnosis.

"The vaccinations received on July 19, 2000, significantly aggravated an underlying mitochondrial disorder," the concession says, "which predisposed her to deficits in cellular energy metabolism, and manifested as a regressive encephalopathy with features of ASD."

This statement is good news for the girl and her family, who will now be compensated for the lifetime of care she will require. But its implications for the larger vaccine-autism debate, and for public health policy in general, are not as certain.

In fact, the government's concession seems to raise more questions than it answers.

1) Is there a connection between vaccines, mitochondrial disorders and a diagnosis of autism, at least in some cases?

Mitochondria, you may recall from biology class, are the little powerhouses within cells that convert food into electrical energy, partly through a complex process called "oxidative phosphorylation." If this process is impaired, mitochondrial disorder will ensue.

The child in this case had several markers for Mt disease, which was confirmed by muscle biopsy. Mt disease is often marked by lethargy, poor muscle tone, poor food digestion and bowel problems, something found in many children diagnosed with autism.

But mitochondrial disorders are rare in the general population, affecting some 2-per-10,000 people (or just 0.2%). So with 4,900 cases filed in Vaccine Court, this case should be the one and only, extremely rare instance of Mt disease in all the autism proceedings.

But it is not.

Mitochondrial disorders are now thought to be the most common disease associated with ASD. Some journal articles and other analyses have estimated that 10% to 20% of all autism cases may involve mitochondrial disorders, which would make them one thousand times more common among people with ASD than the general population.

Another article, published in the Journal of Child Neurology and co-authored by Dr. Zimmerman, showed that 38% of Kennedy Krieger Institute autism patients studied had one marker for impaired oxidative phosphorylation, and 47% had a second marker.

The authors -- who reported on a case-study of the same autism claim conceded in Vaccine Court – noted that "children who have (mitochondrial-related) dysfunctional cellular energy metabolism might be more prone to undergo autistic regression between 18 and 30 months of age if they also have infections or immunizations at the same time."

An interesting aspect of Mt disease in autism is that, with ASD, the mitochondrial disease seems to be milder than in "classic" cases of Mt disorder. In fact, classic Mt disease is almost always inherited, either passed down by the mother through mitochondrial DNA, or by both parents through nuclear DNA.

In autism-related Mt disease, however, the disorder is not typically found in other family members, and instead appears to be largely of the sporadic variety, which may now account for 75% of all mitochondrial disorders.

Meanwhile, an informal survey of seven families of children with cases currently pending in Vaccine Court revealed that all seven showed markers for mitochondrial dysfunction, dating back to their earliest medical tests. The facts in all seven claims mirror the case just conceded by the government: Normal development followed by vaccination, immediate illness, and rapid decline culminating in an autism diagnosis.

2) With 4,900 cases pending, and more coming, will the government concede those with underlying Mt disease -- and if it not, will the Court award compensation?

The Court will soon begin processing the 4900 cases pending before it. What if 10% to 20% of them can demonstrate the same Mt disease and same set of facts as those in the conceded case? Would the government be obliged to concede 500, or even 1,000 cases? What impact would that have on public opinion? And is there enough money currently in the vaccine injury fund to cover so many settlements?

When asked for a comment last week about the court settlement, a spokesman for HHS furnished the following written statement:

"DVIC has reviewed the scientific information concerning the allegation that vaccines cause autism and has found no credible evidence to support the claim. Accordingly, in every case under the Vaccine Act, DVIC has maintained the position that vaccines do not cause autism, and has never concluded in any case that autism was caused by vaccination."

3) If the government is claiming that vaccines did not "cause" autism, but instead aggravated a condition to "manifest" as autism, isn't that a very fine distinction?

For most affected families, such linguistic gymnastics is not so important. And even if a vaccine injury "manifested" as autism in only one case, isn't that still a significant development worthy of informing the public?

On the other hand, perhaps what the government is claiming is that vaccination resulted in the symptoms of autism, but not in an actual, factually correct diagnosis of autism itself.

4) If the government is claiming that this child does NOT have autism, then how many other children might also have something else that merely "mimics" autism?

Is it possible that 10%-20% of the cases that we now label as "autism," are not autism at all, but rather some previously undefined "look-alike" syndrome that merely presents as "features" of autism?

This question gets to the heart of what autism actually is. The disorder is defined solely as a collection of features, nothing more. If you have the features (and the diagnosis), you have the disorder. The underlying biology is the great unknown.

But let's say the government does determine that these kids don't have actual "autism" (something I speculated on HuffPost a year ago). Then shouldn't the Feds go back and test all people with ASD for impaired oxidative phosphorylation, perhaps reclassifying many of them?

If so, will we then see "autism" cases drop by tens, if not hundreds of thousands of people? Will there be a corresponding ascension of a newly described disorder, perhaps something like "Vaccine Aggravated Mitochondrial Disease with Features of ASD?"

And if this child was technically "misdiagnosed" with DSM-IV autism by Dr Zimmerman, how does he feel about HHS doctors issuing a second opinion re-diagnosis of his patient, whom they presumably had neither met nor examined? (Zimmerman declined an interview).

And along those lines, aren't Bush administration officials somewhat wary of making long-distance, retroactive diagnoses from Washington, given that the Terry Schiavo incident has not yet faded from national memory?

5) Was this child's Mt disease caused by a genetic mutation, as the government implies, and wouldn't that have manifested as "ASD features" anyway?

In the concession, the government notes that the patient had a "single nucleotide change" in the mitochondrial DNA gene T2387C, implying that this was the underlying cause of her manifested "features" of autism.

While it's true that some inherited forms of Mt disease can manifest as developmental delays, (and even ASD in the form of Rhett Syndrome) these forms are linked to identified genetic mutations, of which T2387C is not involved. In fact little, if anything, is known about the function of this particular gene.

What's more, there is no evidence that this girl, prior to vaccination, suffered from any kind of "disorder" at all- genetic, mitochondrial or otherwise. Some forms of Mt disease are so mild that the person is unaware of being affected. This perfectly developing girl may have had Mt disorder at the time of vaccination, but nobody detected, or even suspected it.

And, there is no evidence to suggest that this girl would have regressed into symptoms consistent with a DSM-IV autism diagnosis without her vaccinations. If there was such evidence, then why on earth would these extremely well-funded government attorneys compensate this alleged injury in Vaccine Court? Why wouldn't they move to dismiss, or at least fight the case at trial?

6) What are the implications for research?

The concession raises at least two critical research questions: What are the causes of Mt dysfunction; and how could vaccines aggravate that dysfunction to the point of "autistic features?"

While some Mt disorders are clearly inherited, the "sporadic" form is thought to account for 75% of all cases, according to the United Mitochondrial Disease Foundation. So what causes sporadic Mt disease? "Medicines or other toxins," says the Cleveland Clinic, a leading authority on the subject.
Use of the AIDS drug AZT, for example, can cause Mt disorders by deleting large segments of mitochondrial DNA. If that is the case, might other exposures to drugs or toxins (i.e., thimerosal, mercury in fish, air pollution, pesticides, live viruses) also cause sporadic Mt disease in certain subsets of children, through similar genotoxic mechanisms?

Among the prime cellular targets of mercury are mitochondria, and thimerosal-induced cell death has been associated with the depolarization of mitochondrial membrane, according to the International Journal of Molecular Medicine among several others. (Coincidently, the first case of Mt disease was diagnosed in 1959, just 15 years after the first autism case was named, and two decades after thimerosal's introduction as a vaccine preservative.)

Regardless of its cause, shouldn't HHS sponsor research into Mt disease and the biological mechanisms by which vaccines could aggravate the disorder? We still do not know what it was, exactly, about this girl's vaccines that aggravated her condition. Was it the thimerosal? The three live viruses? The two attenuated viruses? Other ingredients like aluminum? A combination of the above?

And of course, if vaccine injuries can aggravate Mt disease to the point of manifesting as autism features, then what other underlying disorders or conditions (genetic, autoimmune, allergic, etc.) might also be aggravated to the same extent?

7) What are the implications for medicine and public health?

Should the government develop and approve new treatments for "aggravated mitochondrial disease with ASD features?" Interestingly, many of the treatments currently deployed in Mt disease (i.e., coenzyme Q10, vitamin B-12, lipoic acid, biotin, dietary changes, etc.) are part of the alternative treatment regimen that many parents use on their children with ASD.

And, if a significant minority of autism cases can be linked to Mt disease and vaccines, shouldn't these products one day carry an FDA Black Box warning label, and shouldn't children with Mt disorders be exempt from mandatory immunization?

8) What are the implications for the vaccine-autism debate?

It's too early to tell. But this concession could conceivably make it more difficult for some officials to continue insisting there is "absolutely no link" between vaccines and autism.

It also puts the Federal Government's Vaccine Court defense strategy somewhat into jeopardy. DOJ lawyers and witnesses have argued that autism is genetic, with no evidence to support an environmental component. And, they insist, it's simply impossible to construct a chain of events linking immunizations to the disorder.

Government officials may need to rethink their legal strategy, as well as their public relations campaigns, given their own slightly contradictory concession in this case.

9) What is the bottom line here?

The public, (including world leaders) will demand to know what is going on inside the US Federal health establishment. Yes, as of now, n=1, a solitary vaccine-autism concession. But what if n=10% or 20%? Who will pay to clean up that mess?

The significance of this concession will unfortunately be fought over in the usual, vitriolic way – and I fully expect to be slammed for even raising these questions. Despite that, the language of this concession cannot be changed, or swept away.

Its key words are "aggravated" and "manifested." Without the aggravation of the vaccines, it is uncertain that the manifestation would have occurred at all.

When a kid with peanut allergy eats a peanut and dies, we don't say "his underlying metabolic condition was significantly aggravated to the extent of manifesting as an anaphylactic shock with features of death."

No, we say the peanut killed the poor boy. Remove the peanut from the equation, and he would still be with us today.

Many people look forward to hearing more from HHS officials about why they are settling this claim. But whatever their explanation, they cannot change the fundamental facts of this extraordinary case:

The United State government is compensating at least one child for vaccine injuries that resulted in a diagnosis of autism.
And that is big news, no matter how you want to say it.

NOTE: Full text of the government's statement is posted here.

David Kirby is the author of "Evidence of Harm - Mercury in Vaccines and the Autism Epidemic, A Medical Controversy" (St. Martins Press 2005.

Autism Rates Increase to 1 in 91 Children
October 2009

Yesterday, in the October issue of in the American Academy of Pediatrics' journal Pediatrics found a parent-reported autism prevalence rate of 1 in every 91 American children, including 1 in every 58 boys. The previous statistic was 1 in every 150 children were affected by autism.

Where did the new statistic come from? The Health Resources and Services Administration (HRSA) and Centers for Disease Control and Prevention (CDC) funded a national survey to keep track of the prevalence of autism in the United States. The National Survey of Children's Health (NSCH), did a phone survey of more than 78,000 parents of children aged 3 to 17 years. These parents were asked whether their child currently had an autism spectrum disorder (ASD) diagnosis - including autism, Asperger's syndrome, pervasive developmental disorder, or another ASD or whether their child had been given that diagnosis in the past, but was no longer diagnosed with ASD.

What is behind the numbers? Is it truly an increase in the number of cases of autism or is it a reflection of physicians and healthcare providers being more aware of the signs of autism and making more diagnosis? Many people are commenting that the level of awareness of the last 5 years has yielded more screening tools and diagnosing the disorder sooner.

Whether the increase in numbers is a reflection of better detection or and increase in cases...these new findings reinforce that autism is an urgent and growing public health crisis that affects most individuals across their lifespan and demands a commensurate level of action from both the public and private sectors.

Wellspring's purpose is to enhance as many lives as possible that are affect by autism by changing children's behavior to be more typical of their peers. Call us today if you are in need of services.

Population Screening Reveals Dramatically Higher Autism Rates
South Korean Study Suggests Many Missed Diagnoses in General Population

http://www.autismspeaks.org/science/science-news/top-ten-lists/2011/population-screening-reveals-dramatically-higher-autism-rate

A South Korean study that directly screened schoolchildren for autism spectrum disorder (ASD) revealed a prevalence of 1 in 38 children, or 2.6 percent. Two-thirds of the affected children were in mainstream classrooms, previously undiagnosed and receiving no services.

The finding, published in the American Journal of Psychiatry, raises the possibility that the current CDC estimate of autism prevalence in the United States (1 in 110 children, or about 1 percent) may be a considerable underestimate. The U.S. estimate is based on reviews of medical records, rather than the Korean study’s method of direct screening and case confirmation of children in the general community.

The South Korean study covered a wide-ranging population and used gold standard screening and diagnostic tools. Led by Young Shin Kim, M.D., Ph.D., of Yale School of Medicine, it was the first to attempt a rigorous estimate of autism prevalence in the general South Korean population and among the first such prevalence survey outside North America and Europe. It included about 55,000 schoolchildren between the ages of 7 and 12 living in a residential community near the capital city of Seoul. The researchers first screened for autism using parent and teacher questionnaires, then used standardized diagnostic methods to evaluate the children who screened positive.

The findings stress the need for improved and wider autism screening among the general population, the researchers concluded, especially among younger age groups, as early diagnosis and intervention have been shown to improve outcomes. Goyang City, where the study was conducted, now offers autism assessment and intervention services for all children entering first grade.

The study was funded in part by Autism Speaks, which is now working with the CDC to implement a study of community screening in the United States. Even at the current estimate of ASD affecting 1 in 110 US children, more children will be diagnosed with autism in the coming year than with childhood cancer, juvenile diabetes and pediatric AIDS combined.


Kim YS, Leventhal BL, Koh YJ, et al. Prevalence of Autism Spectrum Disorders in a Total Population Sample. Am J Psychiatry. 2011 Sep;168(9):904-12.

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Billstedt, E., Gillberg, I. C., & Gillberg, C. (2005). Autism after Adolescence: Population-based 13- to 22-year Follow-up Study of 120 Individuals with Autism Diagnosed in Childhood. Journal of Autism and Developmental Disorders, 35, 351-360.

ABSTRACT: Individuals with autism demonstrate impairments on measures of executive function (EF) relative to typically developing comparison participants. EF is comprised of several processes including inhibition, working memory and set shifting that develop throughout the lifespan. Impairments in EF may appear early in development and persist, or may represent a more transient delay which resolves with time. Given the unevenness of the cognitive profile of persons with autism, understanding the development of EF poses methodological challenges. These issues include those related to matching measures and the choice of comparison participants to which the performance of persons with autism will be compared. In the current review, we attempt to break down the processes of inhibition, working memory and set shifting among persons with autism. We propose to do this within a developmental perspective that highlights how matching measures and comparison participants can affect the interpretation of research findings. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Bogte, H., Flamma, B., van, d. M., Jaap, & van, E., Herman. (2008). Cognitive flexibility in adults with high functioning autism. Journal of Clinical and Experimental Neuropsychology, 30(1), 33-41.

ABSTRACT: The goal of the current study was to evaluate presetting, response inhibition, set shifting, and a priori planning in autism: abilities that can be lumped together under the term cognitive flexibility. Cognitive flexibility is an aspect of executive functioning, which in turn is mediated by the prefrontal cortical lobes. A group of adults with high-functioning autism (HFA; n=23) were compared with a normal control group (n=32), by using a computerized variant of the Sternberg response bias paradigm. Contrary to the results of earlier studies, no deficit was found in presetting, response inhibition, set shifting, and a priori planning in participants with autism, even when the medication factor was taken into account. Methodological issues that could be explanatory for this difference are discussed. An additional finding was, that individuals with HFA (especially those on medication) were slow in reacting. Possible origins and consequences of this slowness, also for cognitive flexibility, are discussed. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Boucher, J. (2007). Memory and generativity in very high functioning autism: A firsthand account, and an interpretation. Autism, 11, 255-264.

ABSTRACT: JS is a highly able person with Asperger syndrome whose language and intellectual abilities are, and always have been, superior. The first part of this short article consists of JS's analytical account of his atypical memory abilities, and the strategies he uses for memorizing and learning. JS has also described specific difficulties with creative writing, which are outlined here. The second part of the article consists of an interpretation of the problems JS describes in terms of their implications for understanding the problems of generativity that contribute to the diagnostic impairments of imagination and creativity in autism. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Brosnan, M. J., Scott, F. J., Fox, S., & Pye, J. (2004). Gestalt processing in autism: Failure to process perceptual relationships and the implications for contextual understanding. Journal of Child Psychology and Psychiatry, 45, 459-469.

ABSTRACT: Deficits in autism have been characterised as a bias towards local over global processing. This paper examines whether there is a deficit in gestalt grouping in autism. Method: Twenty-five low-functioning children with autism and 25 controls who were matched for chronological age and verbal mental age took part in the study. Results: The autism group utilised gestalt grouping principles (proximity, similarity, closure) significantly less than the controls. Calculating an overall index of gestalt grouping, the autism group performed at chance level. There was also a deficit in identifying certain impossible figures. This pattern was not reflected in a drawing task, in which the autism sample conformed more to gestalt grouping principles than controls (non-significantly). Conclusions: The results are discussed in terms of a failure in autism to process inter-element relationships that would allow for the appreciation of larger perceptually coherent units that comprise of multiple elements and, consequently, context. The processes are argued to be preattentive. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Burack, J. A. (1994). Selective attention deficits in persons with autism: Preliminary evidence of an inefficient attentional lens. Journal of Abnormal Psychology, 103, 535-543.

ABSTRACT: A forced-choice reaction time (RT) task was used to assess the filtering component of selective attention in mental-age (MA) matched groups of persons with autism (n = 12), organic mental retardation (n = 32), familial mental retardation (n = 30), and no handicap (n = 34). Conditions varied with regard to the presence or absence of a window and number (zero, two, or four) and location of distractors. The RTs of the persons with autism improved relative to the other groups in the presence of the window without distractors, but this effect was negated when distractors were also presented. The performance of the persons with autism was the most impaired in the presence of distractors. These findings represent preliminary behavioral evidence of an inefficient attentional lens among persons with autism. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Cashin, A., & Waters, C. (2006). The Undervalued Role of Over-regulation in Autism: Chaos Theory as a Metaphor and Beyond. Journal of Child and Adolescent Psychiatric Nursing, 19, 224-230.

ABSTRACT: A triad of impairment that consists of impaired communication, impaired social skills and over-regulated behavior characterizes autism. Causality of autism is yet to be identified. Therapy has been devised to apply to the work with children and adolescents with a diagnosis of autism in the domains of impaired communication and impaired social skills. Little attention has been paid to the importance of the over-regulated behavior that forms part of the triad of impairment. Purpose: This paper considers this point of over-regulation in the triad of impairment in autism through the lens of Chaos theory. Sources: Contemporary literature on autism and Chaos theory. Conclusions: Implications for nursing practice and research are raised. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Delorme, R., Gouss˝, V., Roy, I., Trandafir, A., Mathieu, F., Mouren, S., Marie Christine et al. (2007). Shared executive dysfunctions in unaffected relatives of patients with autism and obsessive-compulsive disorder. European Psychiatry, 22, 32-38.

ABSTRACT: Executive dysfunctions have been studied as a potential endophenotype associated with the genetic basis of autism. Given that recent findings from clinical and molecular genetic studies suggest that autism and obsessive-compulsive disorder (OCD) could share a common pattern of heritability, we assessed executive functions as a possible common cognitive endophenotype in unaffected family members of individuals with either autism or OCD. Methods: Five tests assessing executive functions (Tower of London, verbal fluency, design fluency, trail making and association fluency) were proposed to 58 unaffected first-degree relatives (parents and siblings) of probands with autism and 64 unaffected first-degree relatives of OCD patients. Results were compared with those of 47 healthy controls matched for age, sex, and level of education. Results: In the Tower of London test, both groups of unaffected relatives showed significantly lower scores and longer response times compared with controls. No differences were observed between autism and OCD relatives and healthy controls in the four other tasks (verbal fluency, design fluency, trail making test and association fluency). Conclusions: Our findings show the existence of executive dysfunction in the unaffected first-degree relatives of probands with OCD, similar to those observed in the relatives of patients with autism. These results support and extend previous cognitive studies on probands indicating executive dysfunctions in autism and OCD. Planning and working memory processes could thus represent a common cognitive endophenotype in autism and OCD that could help in the identification of genes conferring vulnerability to these disorders. (PsycINFO Database Record (c) 2007 APA, all rights reserved) Gastgeb, H. Z., Strauss, M. S., & Minshew, N. J. (2006). Do Individuals With Autism Process Categories Differently? The Effect of Typicality and Development. Child Development, 77, 1717-1729.

ABSTRACT: This study examined the effect of exemplar typicality on reaction time and accuracy of categorization. High-functioning children (age 9-12), adolescents (age 13-16), and adults with autism (age 17-48) and matched controls were tested in a category verification procedure. All groups showed improved processing throughout the lifespan for typical and somewhat typical category exemplars. However, individuals with autism responded more slowly than matched controls to atypical exemplars at all ages. The results are discussed in terms of potential differences in the type of processing that may be required for categorizing typical and atypical category exemplars. Parallels are also drawn to the results of previous studies on face processing in individuals with autism. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Geurts, H. M., Vert˝, S., Oosterlaan, J., Roeyers, H., & Sergeant, J. A. (2004). How specific are executive functioning deficits in attention deficit hyperactivity disorder and autism? Journal of Child Psychology and Psychiatry, 45, 836-854.

ABSTRACT: The objective of this study is to identify intact and deficient cognitive processes in children with attention deficit hyperactivity disorder (ADHD) and children with high functioning autism (HFA). Method: Three rigorously diagnosed groups of children aged between 6 and 12 years (54 ADHD, 41 HFA, and 41 normal controls) were tested on a wide range of tasks related to five major domains of executive functioning (EF): inhibition, visual working memory, planning, cognitive flexibility, and verbal fluency. In addition, the role of comorbid oppositional defiant disorder (ODD) and comorbid conduct disorder (CD) in ADHD was investigated by directly comparing 20 children with ADHD and 34 children with comorbid ADHD + ODD/CD. Results: ADHD was associated with EF deficits in inhibiting a prepotent response and verbal fluency. Children with HFA demonstrated deficits in all EF domains, except interference control and working memory. The HFA group showed more difficulties than the ADHD group with planning and cognitive flexibility. The comorbid ADHD + ODD/CD group did not show a distinctive pattern of performance on the EF tests compared to the ADHD group. Conclusion: The present study indicates that children with HFA exhibit more generalised and profound problems with EF tasks... (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Goldberg, M. C., Mostofsky, S. H., Cutting, L. E., Mahone, E. M., Astor, B. C., Denckla, M. B. et al. (2005). Subtle Executive Impairment in Children with Autism and Children with ADHD. Journal of Autism and Developmental Disorders, 35, 279-293.

ABSTRACT: The executive functions of inhibition, planning, flexible shifting of actions, and working memory are commonly reported to be impaired in neurodevelopmental disorders. Method: We compared these abilities in children (8-12 years) with high functioning autism (HFA, n = 17), attention deficit-hyperactivity disorder (ADHD, n = 21) and healthy controls (n = 32). Response inhibition was assessed using the Stroop Color and Word Test (Golden, 1978). Problem solving, set-shifting, and nonverbal memory were assessed using three tasks, respectively, from the CANTAB˝ (Cambridge Cognition, 1996): the Stockings of Cambridge task; the Intra-Dimensional/Extra-Dimensidnal set-shifting task; and the Spatial Working Memory task (SWM) with tokens hidden behind 3, 4, 6, and 8 boxes. Results: There were no group differences on the response inhibition, planning, or set-shifting tasks. On the SWM task, children with HFA made significantly more between-search errors compared with controls on both the most difficult problems (8-box) and on the mid-difficulty problems (6-box); however, children with ADHD made significantly more errors compared to controls on the most difficult (8-box) problems only. Conclusion: Our findings suggest that spatial working memory is impaired in both ADHD and HFA, and more severely in the latter. More detailed investigation is needed to examine the mechanisms that differentially impair spatial working memory, but on this set of tasks there appears to be sparing of other executive functions in these neuropsychiatric developmental disorders. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Goldstein, G., Allen, D. N., Minshew, N. J., Williams, D. L., Volkmar, F., Klin, A. et al. (2008). The structure of intelligence in children and adults with high functioning autism. Neuropsychology, 22(3), 301-312.

ABSTRACT: Confirmatory factor analyses of the commonly used 11 subtests of the Wechsler child and adult intelligence scales were accomplished for 137 children and 117 adults with high functioning autism (HFA) and for comparable age groups from the standardization samples contained in the Wechsler manuals. The objectives were to determine whether the structure of intelligence in HFA groups was similar to that found in the normative samples, and whether a separate "social context" factor would emerge that was unique to HFA. Four-factor models incorporating a Social Context factor provided the best fit in both the autism and normative samples, but the subtest intercorrelations were generally lower in the autism samples. Findings suggest similar organization of cognitive abilities in HFA, but with the possibility of underconnectivity or reduced communication among brain regions in autism. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Hala, S., Rasmussen, C., & Henderson, A. M. E. (2005). Three Types of Source Monitoring by Children With and Without Autism: The Role of Executive Function. Journal of Autism and Developmental Disorders, 35, 75-89.

ABSTRACT: Earlier investigations have found mixed evidence of source monitoring impairment in autism. The present study examined three types of source monitoring ability in children with autism and typically developing children. In three different conditions, participants were presented with word lists after which they were required to recall the source of the word for reality, external and internal source monitoring tasks. Group differences were found across all three conditions, with the comparison group outperforming the children with autism. The pattern of performance across the three conditions, however, was comparable for the two groups. Specifically, performance was higher on the reality monitoring task than either the external or internal source tasks. We suggest that the overall impairment found for the children with autism may be due to broader impairments in executive function. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Happe', F., & Booth, R. (2008). The power of the positive: Revisiting weak coherence in autism spectrum disorders. The Quarterly Journal of Experimental Psychology, 61(1), 50-63.

ABSTRACT: This paper reexamines Frith's original concept of weak coherence, its historical origins, recent reformulations, and alternative accounts. We suggest that the key notion of reduced global integration of information, which Frith proposed to underlie the assets in local processing, has been neglected in recent accounts of autism spectrum disorders (ASD). In fact, most paradigms used to test weak coherence conflate global and local processing, often placing them in direct trade-off, so that it is not possible to tell whether patterns of performance in ASD reflect reduced global processing, increased local processing, or both. We review the literature from typical development and ASD that may be pertinent to this distinction and examine some data from our own studies. Only once tasks are devised that measure separately the effects of reduced global processing and increased local processing will it be possible to test the on-line and developmental relations between these two aspects of "weak coherence". Some preliminary ideas about these relationships are discussed, and suggestions are made for why disentangling two possibly independent dimensions of weak coherence may be timely and productive. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Hobson, R. P. (2007). On being moved in thought and feeling: An approach to autism. New developments in autism: The future is today., 139-154.

ABSTRACT: I can explain the title of this chapter, 'On being moved in thought and feeling: An approach to autism', because I want to approach the question 'What is autism?' from a fresh starting-point, one that encompasses a particular view of typical development. The view is that early interpersonal experience is critically important for the acquisition of cognitive as well as social abilities. On the other side to this coin is a thesis about what makes autism 'autism'. The thesis is closely allied to Kanner's (1943) suggestion that the children have 'inborn disturbances of affective contact'. The story is one that focuses both on what individual children lack by way of the necessary equipment to achieve fully-fledged intersubjective engagement with others, and what follows by way of interference with the kinds of interpersonal process that normally promote flexibility in children's thinking and attitudes. The central idea is that being moved by others--and here I am talking about movement in subjective orientation, especially as these involve feelings and attitudes--is one of the most significant features of human social life. It is foundational for experiencing people as people with their own subjective orientations to the world, for evolving forms of self-other awareness, for the construction of increasingly sophisticated concepts about the mind ('theory of mind'), for self-reflection and aspects of executive functioning, and for the kinds of symbolic functioning and flexible stance in relation to the world that contribute so much to human creativity in thinking and action. Of course it will not be possible for me to argue for each and every one of these claims. I have tried to do so in two books (Hobson 1993, 2002), of which the most recent (The Cradle of Thought) is intended to be reader-friendly to a wide audience. What I shall try to do in this contribution is to illustrate what I mean by 'being moved'. I shall do this by citing specific studies, mainly but not exclusively conducted in the Developmental Psychopathology Research Unit, Tavistock Clinic and University College London. En route, I shall offer some reflections on the implications of the findings for our notion of what is 'basic' to autism. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Hughes, C., Russell, J., & Robbins, T. W. (1994). Evidence for executive dysfunction in autism. Neuropsychologia, 32, 477-492.

ABSTRACT: Administered 2 tests of executive function to autistic Ss and control Ss to show that impairments in executive control (EC) also exist in the larger population of less able individuals with autism. 35 autistic Ss (aged 7-18 yrs) and 2 control groups of 38 nonautistic Ss with moderate learning disabilities (MLDs) and 47 normal Ss completed an intradimensional-extradimensional set-shifting test. 30 autistic Ss (aged 8-19 yrs), 37 Ss with MLDs, and 44 normal Ss completed the Tower of London planning task. On each task, autistic Ss were differentially impaired with respect to controls. This impairment was specific to the stages of each task that placed greatest demands on EC. Results demonstrate significant executive dysfunction in autism in the domains of attentional set-shifting and planning. The lack of association between performances on the 2 tasks suggests separable elements of EC. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Iarocci, G., I. (2003). Global and local perception in autism: The role of basic and higher-order attention. Univ Microfilms International, US.

ABSTRACT: This study focused on specific conceptual, methodological and developmental issues pertinent to investigating the role of attention in global-local processing among high-functioning children with autism (average verbal mental age (MA) of 89 months and nonverbal MA of 116 months) as compared to their verbal and nonverbal MA matched peers. Two experiments were conducted to assess separately basic processing; focal attention that is drawn by the physical properties of the stimuli and higher-order processing associated with strategically directing attention in accordance with the observer's priorities within a given task. These components of attention are implicated in the typical development of global-local perceptual organization. In Experiment 1, a visual search task was used to explore the role of basic focal attention to perceptually group dots at either a long or short spatial range. In Experiment 2, a visual search and target identification task was used to assess higher-order voluntary control of attention to the global or the local level of a hierarchical geometric pattern. To assess changes in voluntary attending to a specific target level, an implicit manipulation of increased probability of the target appearing at the global or local level or equally at both levels was included. The main finding was that high-functioning children with autism and their verbal and nonverbal MA matched peers showed comparable focused attention to perceptually organize stimuli over a short or long spatial range but different higher-order attentional processing of hierarchical global-local targets. In all groups, search efficiency for long range targets decreased as a function of display size but the search for short range targets was efficient regardless of display size. Long range grouping performance involves goal-driven, focused attention that is constrained by serial inspection whereas the short range grouping performance implicates a sensory-driven, preattentive spatial-indexing mechanism. At higher levels of attentional control, high-functioning children with autism show a preference for using a local attentional strategy whereas their typically developing peers rely on a global attentional strategy to search for hierarchical global-local targets among distractors. The particular style of visual processing used to search for targets was not influenced by implicit changes in the probability of a target appearing at the local or global level. The findings support the interpretation that a perceptual disturbance in global-local processing in persons with autism may be associated with different higher-order strategy-based processing rather than an enhanced ability to integrate features. (PsycINFO Database Record (c) 2004 APA, all rights reserved)

Johnson, K. A., Robertson, I. H., Kelly, S. P., Silk, T. J., Barry, E., D˝ibhis, A. et al. (2007). Dissociation in performance of children with ADHD and high-functioning autism on a task of sustained attention. Neuropsychologia, 45, 2234-2245.

ABSTRACT: Attention deficit hyperactivity disorder (ADHD) and autism are two neurodevelopmental disorders associated with prominent executive dysfunction, which may be underpinned by disruption within fronto-striatal and fronto-parietal circuits. We probed executive function in these disorders using a sustained attention task with a validated brain-behaviour basis. Twenty-three children with ADHD, 21 children with high-functioning autism (HFA) and 18 control children were tested on the Sustained Attention to Response Task (SART). In a fixed sequence version of the task, children were required to withhold their response to a predictably occurring no-go target (3) in a 1-9 digit sequence; in the random version the sequence was unpredictable. The ADHD group showed clear deficits in response inhibition and sustained attention, through higher errors of commission and omission on both SART versions. The HFA group showed no sustained attention deficits, through a normal number of omission errors on both SART versions. The HFA group showed dissociation in response inhibition performance, as indexed by commission errors. On the Fixed SART, a normal number of errors was made, however when the stimuli were randomised, the HFA group made as many commission errors as the ADHD group. Greater slow-frequency variability in response time and a slowing in mean response time by the ADHD group suggested impaired arousal processes. The ADHD group showed greater fast-frequency variability in response time, indicative of impaired top-down control, relative to the HFA and control groups. These data imply involvement of fronto-parietal attentional networks and sub-cortical arousal systems in the pathology of ADHD and prefrontal cortex dysfunction in children with HFA. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Kaland, N., Smith, L., & Mortensen, E. L. (2008). Brief report: Cognitive flexibility and focused attention in children and adolescents with Asperger syndrome or high-functioning autism as measured on the computerized version of the Wisconsin Card Sorting Test. Journal of Autism and Developmental Disorders, 38(6), 1161-1165.

ABSTRACT: The aim of the present study was to assess mental flexibility and set maintenance of a group of individuals with Asperger syndrome (AS) or high-functioning autism (HFA) (N = 13; mean age 16,4), as compared with a matched group of typically developing children and adolescents (N = 13; mean age 15,6) on the computerized version of the Wisconsin Card Sorting Test (WCST). The participants in the AS/HFA group performed less well than the controls on all categories of the WCST, but the differences did not reach conventional statistical significance on most categories of the WCST. On the category failure to maintain set, however, the AS/HFA participants performed significantly less well than the controls, suggesting a deficit of focused attention. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Klin, A., Jones, W., Schultz, R., T., & Volkmar, F., R. (2005). The Enactive Mind-From Actions to Cognition: Lessons from Autism., 682-703.

ABSTRACT: This chapter begins with an intriguing puzzle posed by normative-IQ individuals with autism. One of the most intriguing puzzles posed by individuals with autism is the great discrepancy between what they can do on explicit tasks of social reasoning and what they fail to do in more naturalistic situations. This chapter examines the social world as an open-domain task, developmental and contextual elements in the emergence of mental representations, temporal constraints on models of social adaptation, social cognition as social action. Collectively, the various examples presented here suggest a need to explain the discrepancy between performance on structured and explicit as against naturalistic and spontaneous tasks and, in so doing, to explore what might be a unique social developmental path evidenced in autism. This chapter contends that theories of the social dysfunction in autism need to address both of these phenomena. The framework presented is called enactive mind (EM) to highlight the central role of motivational predispositions to respond to social stimuli and a developmental process in which social cognition results from social action. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

Landa, R. J., & Goldberg, M. C. (2005). Language, Social, and Executive Functions in High Functioning Autism: A Continuum of Performance. Journal of Autism and Developmental Disorders, 35, 557-573.

ABSTRACT: This study examined language and executive functions (EF) in high-functioning school-aged individuals with autism and individually matched controls. Relationships between executive, language, and social functioning were also examined. Participants with autism exhibited difficulty on measures of expressive grammar, figurative language, planning, and spatial working memory. A mixed profile of impaired and enhanced abilities was noted in set-shifting. While controls showed the typical increase in errors when shifting sets from an intra-dimensional to an extra-dimensional stimulus, this pattern was not noted in participants with autism. Relationships between EF, language, and social performance were weak to nonexistent. Implications for theories of core deficit in autism and dissociable nature of the language and executive impairments in autism are discussed. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Landry, R., & Bryson, S. E. (2004). Impaired disengagement of attention in young children with autism. Journal of Child Psychology and Psychiatry, 45, 1115-1122.

ABSTRACT: The present study examined the disengage and shift operations of visual attention in young children with autism. Methods: For this purpose, we used a simple visual orienting task that is thought to engage attention automatically. Once attention was first engaged on a central fixation stimulus, a second stimulus was presented on either side, either simultaneously or successively. Latency to begin an eye movement to the peripheral stimulus served as the main dependent measure. The two stimulus conditions (simultaneous and successive) provided independent measures of disengaging and shifting attention, respectively. Performance of children with autism was compared to that of children with Down syndrome and a normal group. Results: The main finding was that relative to both comparison groups, children with autism had marked difficulty in disengaging attention. Indeed, on 20% of trials they remained fixated on the first of two competing stimuli for the entire 8-second trial duration. Evidence is also provided for a more subtle problem in executing rapid shifts of attention. Conclusions: Our findings on disengagement in autism parallel those reported in normal 2- month-olds, in whom attention has been described as 'obligatory.' Discussion focuses on the potential role of general versus domain-specific processes in producing some of the core features of autism. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Luna, B., Doll, S. K., Hegedus, S. J., Minshew, N. J., & Sweeney, J. A. (2007). Maturation of Executive Function in Autism. Biological Psychiatry, 61, 474-481.

ABSTRACT: Executive dysfunction has been reported at different ages in autism. It is not clear however, when this impairment emerges or how its expression is affected by development. Methods: 61 non-mentally retarded autism participants (AUT) and 61 age, gender, and IQ matched typically developing participants (CON) were assessed with two oculomotor executive function tasks, the oculomotor delayed response task (ODR) and the antisaccade task (AS), as well as a visually-guided saccade sensorimotor task (VGS). Results: The AUT group demonstrated impairments in response inhibition and spatial working memory at all ages tested. Developmental improvements in speed of sensorimotor processing and voluntary response inhibition were similar in both groups indicating sparing of some attentional control of behavior. Developmental progression in the speed of initiating a cognitive plan and maintaining information on line over time, however, was impaired in the AUT group indicating abnormal development of working memory. Conclusions: These results indicate that while executive dysfunction is present throughout development, there is evidence for both typical and atypical developmental progression of executive functions in autism. The plasticity suggested by the developmental improvements may have implications regarding appropriate developmental epochs and types of interventions aimed at enhancing cognitive capacities in individuals with autism. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Minshew, N. J., Sweeney, J., & Luna, B. (2002). Autism as a selective disorder of complex information processing and underdevelopment of neocortical systems. Molecular Psychiatry, 7, S14-S15.

ABSTRACT: Autism is now widely accepted as being a developmental neurobiologic disorder of polygenetic origin. The cause of autism is viewed as a cascade of events occurring across genetic, developmental neurobiologic, neural, cognitive and neurologic, and behavioral levels. The conceptualization of autism as a selective disorder of complex information processing identifies a common denominator of all the cognitive and neurologic manifestations of this syndrome, thus unifying the syndrome at a clinical level. The neural basis of the cognitive deficits in autism has been investigated with saccadic eye movements. The studies have provided evidence that autism is a disorder of information processing in general, and complex information processing in particular. They further demonstrated that these cognitive deficits are the result of dysfunction of neocortical systems and of the under incorporation of higher brain regions into these neural systems. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Ozonoff, S., South, M., & Provencal, S. (2007). Executive functions in autism: Theory and practice. New developments in autism: The future is today., 185-213.

ABSTRACT: The chapter also appeared in The Handbook of Autism and Pervasive Developmental Disorders, Volume 1, Diagnosis, Development, Neurobiology, and Behaviour, 3rd Edition, edited by F. R. Volkmar, R. Paul, A. Klin and D. J. Cohen. Executive function is the cognitive construct used to describe goal-directed, future-oriented behaviors thought to be mediated by the frontal lobes, including planning, inhibition of prepotent responses, flexibility, organized search, self-monitoring, and use of working memory. Executive dysfunction has been found in both individuals with autism and their family members, across many ages and functioning levels, on many different instruments purported to measure executive function. This chapter summarizes this still growing literature. We explore a number of issues that have emerged in the executive function literature as the field has matured, including the developmental trajectory of executive function, its relation to other cognitive abilities and features of autism, and its association with other neurodevelopmental disorders. We conclude the chapter with thoughts about future research directions, including new findings that executive dysfunction may be familial and suggestions for remediation. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Reed, T. (2002). Visual perspective taking as a measure of working memory in participants with autism. Journal of Developmental and Physical Disabilities, 14, 63-76.

ABSTRACT: Notes that there is mounting evidence that people with autism have executive function deficits and that those deficits are linked to the social impairment characteristic of autism. L. Bennetto et al. (1996) suggest that, more specifically, people with autism may have a deficit in working memory. This hypothesis was tested using a visual perspective-taking task whose working memory load could be systematically varied. Three groups of Ss participated in this study: participants with autism (aged 5.2-39.11 yrs; 10 of whom were also mildly retarded), participants with retardation (aged 3.1-17 yrs; who were not autistic), and typically developing participants (aged 6.4-52 yrs). The performance of participants with autism on this task was significantly worse than that of the control participants. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Rehfeldt, R. A., Dillen, J. E., Ziomek, M. M., & Kowalchuk, R. K. (2007). Assessing Relational Learning Deficits in Perspective-Taking in Children with High-Functioning Autism Spectrum Disorder. Psychological Record, 57, 23-47.

ABSTRACT: Perspective-taking, or the ability to demonstrate awareness of informational states in oneself and in others, has been of recent interest in behavioral psychology. This is, in part, a result of a modern behavioral approach to human language and cognition known as Relational Frame Theory, which views perspective-taking as generalized operant behavior based upon a history of reinforcement for relational responding. Previous lines of research have developed a behavioral protocol for assessing relational learning deficits in perspective-taking and have implicated the lack of perspective-taking as a basis for the social deficits observed in children with autism. However, no empirical investigations have been conducted on relational learning deficits in perspective-taking with autistic populations. The present paper reports 2 experiments that investigated whether children with autism spectrum disorder demonstrated relational learning deficits in a perspective-taking task as compared to their age-matched typically developing peers. We also investigated whether accuracy in perspective-taking correlated with scores on standardized instruments commonly used in the assessment of autism spectrum disorder, and whether relational responding in perspective-taking improves following a history of reinforcement for such responding. Results of Experiment 1 demonstrated statistically significant differences in errors as a function of type of relation, while visual inspection revealed that participants with autism spectrum disorder made more errors than typically developing children on 2 of the 3 types of relations examined. Results of Experiment 2 illustrated that a history of reinforced relational responding improved performance on the perspective-taking task. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Ruble, L. A., & Scott, M. M. (2002). Executive functions and the natural habitat behaviors of children with autism. Autism, 6, 365-381.

ABSTRACT: An ecological method first described by R. Barker and H. Wright and adapted by M. Scott was used to assess the patterns of goal-directed behaviors of 8 6-10 yr old males with autism and 8 chronological and mental age comparable children with Down syndrome. Quantitative and qualitative features of naturalistic behaviors were collected, and coded using previously described categories of children's behavior. Results indicate that children with autism exhibited shorter and less overlapping goal-directed behaviors. It is concluded that these data suggest a cognitive difference rather than developmental delay, and lend support for impaired executive functions in autism. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Russo, N., Flanagan, T., Iarocci, G., Berringer, D., Zelazo, P. D., & Burack, J. A. (2007). Deconstructing executive deficits among persons with autism: Implications for cognitive neuroscience. Brain and Cognition, 65(1), 77-86.

ABSTRACT: Individuals with autism demonstrate impairments on measures of executive function (EF) relative to typically developing comparison participants. EF is comprised of several processes including inhibition, working memory and set shifting that develop throughout the lifespan. Impairments in EF may appear early in development and persist, or may represent a more transient delay which resolves with time. Given the unevenness of the cognitive profile of persons with autism, understanding the development of EF poses methodological challenges. These issues include those related to matching measures and the choice of comparison participants to which the performance of persons with autism will be compared. In the current review, we attempt to break down the processes of inhibition, working memory and set shifting among persons with autism. We propose to do this within a developmental perspective that highlights how matching measures and comparison participants can affect the interpretation of research findings. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Solomon, M., Ozonoff, S. J., Cummings, N., & Carter, C. S. (2008). Cognitive control in autism spectrum disorders. International Journal of Developmental Neuroscience, 26(2), 239-247.

ABSTRACT: Cognitive control refers to the ability to flexibly allocate mental resources to guide thoughts and actions in light of internal goals. Given the behavioral inflexibility exhibited by individuals with autism spectrum disorders (ASDs), it would appear they experience cognitive control deficits. Cognitive correlates of this behavioral inflexibility have been elusive in previous investigations. Study goals were to investigate deficits in cognitive control in ASDs; to explore its developmental trajectory; and to test whether control deficits are related to symptoms of inflexible thoughts and/or behaviors, and attention symptoms. Thirty-one children and adolescents aged 8-17 with ASDs and 32 age, IQ, and gender matched control subjects completed cognitive, diagnostic, and behavioral assessments, as well as a measure of cognitive control involving overcoming a prepotent response tendency. Compared with typically developing control subjects, individuals with ASDs exhibited deficits in cognitive control. Younger children with ASDs did not demonstrate age-related improvements in cognitive control. Modest relationships between cognitive control, IQ, and attention problems were found for the sample. Only the relationship between cognitive control and full-scale IQ survived correction for multiple comparisons. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Szatmari, P., Georgiades, S., Bryson, S., Zwaigenbaum, L., Roberts, W., Mahoney, W. et al. (2006). Investigating the structure of the restricted, repetitive behaviours and interests domain of autism. Journal of Child Psychology and Psychiatry, 47(6), 582-590.

ABSTRACT: The Restricted, Repetitive Behaviours and Interests (RRBIs) are represented in the DSM-IV and measured by the Autism Diagnostic Interview-Revised (ADI-R) as one of the three homogeneous symptom categories of Pervasive Developmental Disorders. Although this conceptualisation is well accepted in the field, the grouping of symptoms is based primarily on clinical judgment rather than on empirical evidence. Methods: The objective of this study was to examine the factor structure of the RRBI domain of autism. Eleven items from this domain of the ADI-R were used in a Principal Components Analysis (PCA). Our sample consisted of 339 individuals with a Best Estimate diagnosis of Pervasive Developmental Disorder (PDD). Results: Findings indicate that the RRBI domain is composed of two distinct factors or dimensions: Insistence on Sameness (IS) and Repetitive Sensory and Motor Behaviours (RSMB). RSMB is negatively correlated with adaptive skills; that is, lower functioning individuals tend to have higher levels of repetitive sensory and motor behaviours. On the other hand, IS is positively correlated with autistic symptoms in the communication and language domain. Further analyses suggest moderate familial aggregation among affected sibling pairs within the IS but not the RSMB factor. Conclusions: These results provide evidence for the heterogeneity of the RRBI domain of the ADI-R in terms of both clinical presentation and other correlates. In addition, the IS factor seems to be under familial (presumably genetic) control, while RSMB appears to simply reflect variation in developmental level. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

Toichi, M., Kamio, Y., Okada, T., Sakihama, M., Youngstrom, E., A., Findling, R., L. et al. (2002). A lack of self-consciousness in autism. American Journal of Psychiatry, 159(8), 1422-1424.

ABSTRACT: Investigated self-consciousness in autism. An incidental memory task was conducted on 18 adults with high-functioning autism (mean age 23.0 yrs) and 18 normal comparison Ss (mean age 24.5 yrs). Three kinds of orienting questions (phonological, semantic, and self-referent, i.e., "Does the word describe you?") were asked about target words (adjectives for personality traits) in order to induce different types of processing. This was followed by an unexpected recognition test. Results show that while semantic processing resulted in better memory than phonological processing in both groups, self-referent processing yielded better memory performance than semantic processing in the comparison group but not in the autistic group. The results suggest deficits in self-consciousness in individuals with autism. (PsycINFO Database Record (c) 2004 APA, all rights reserved)

New York Times – Autism in Korea 5-2011

www.nytimes.com

Study in Korea Puts Autism's Prevalence at 2.6%, Surprising Experts

By CLAUDIA WALLIS

Published: May 9, 2011

An ambitious six-year effort to gauge the rate of childhood autism in a middle-class South Korean city has yielded a figure that stunned experts and is likely to influence the way the disorder's prevalence is measured around the world, scientists reported on Monday.

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The figure, 2.6 percent of all children aged 7 to 12 in the Ilsan district of the city of Goyang, is more than twice the rate usually reported in the developed world. Even that rate, about 1 percent, has been climbing rapidly in recent years — from 0.6 percent in the United States in 2007, for example.

But experts said the findings did not mean that the actual numbers of children with autism were rising, simply that the study was more comprehensive than previous ones.

"This is a very impressive study," said Lisa Croen, director of the autism research program at Kaiser-Permanente Northern California, who was not connected with the new report. "They did a careful job and in a part of the world where autism has not been well documented in the past."

For the study, which is being published in The American Journal of Psychiatry, researchers from the Yale Child Study Center, George Washington University and other leading institutions sought to screen every child aged 7 to 12 in Ilsan, a community of 488,590, about the size of Staten Island.

By contrast, the Centers for Disease Control and Prevention in the United States and most other research groups measure autism prevalence by examining and verifying records of existing cases kept by health care and special education agencies. That approach may leave out many children whose parents and schools have never sought a diagnosis.

In recent years scientists have come to see autism as a spectrum of disorders that can include profound social disconnection and mental retardation, but also milder forms, like Asperger's syndrome, that are pervasive and potentially disabling but that often go undiagnosed.

"From the get-go we had the feeling that we would find a higher prevalence than other studies because we were looking at an understudied population: children in regular schools," said the lead researcher, Dr. Young-Shin Kim, a child psychiatrist and epidemiologist at the Yale Child Study Center.

South Korea was chosen not only because autism prevalence had not been measured there, but also because its national health care system, universal education and homogeneous population made it a promising region for a planned series of studies that will also look at genetic and environmental factors in autism.

The study, which was largely financed by the research and advocacy group Autism Speaks, raises the question of whether a similarly high prevalence would be found in the United States if all children were screened.

Dr. Marshalyn Yeargin-Allsopp, chief of developmental disabilities at the National Center on Birth Defects and Developmental Disabilities of the C.D.C., acknowledged that her agency's records-based approach probably missed some autistic children — especially among the poor, among racial minorities and "potentially among girls" — and said the agency was interested in taking part in a population-based approach like the Korean study.

"We believe this will be a way to get as complete an estimate of A.S.D. prevalence as possible," she said in an e-mail, using the abbreviation for autism spectrum disorder.

Most cases of autism spectrum disorder in the Korean study, the researchers said, turned up among children in regular schools who had no record of receiving special education or mental health services. A third were found among a "high-probability group" of 294 children who were attending special-education schools or were listed on a registry of disabled children.

The children in that high-probability group were similar in many ways to children with autism in the United States and elsewhere. Fifty-nine percent were intellectually disabled, or mentally retarded; more than two-thirds had full-blown autism, as opposed to milder forms like Asperger's; and boys outnumbered girls five to one.

Among the children with autism spectrum disorder in regular schools, only 16 percent were intellectually disabled, more than two-thirds had a milder form of autism, and the ratio of boys to girls was unusually low: 2.5 to 1.

In addition, 12 percent of these children had a superior I.Q. — a higher proportion than found in the general population.

Researchers used a two-step process to identify autism among ordinary schoolchildren: parents and teachers completed a 27-item questionnaire on each child, and children who scored in the autistic range on that questionnaire were individually evaluated.

"If we had only looked at the high-probability group, we would have come up with about 0.7 percent, which is in line with C.D.C. statistics for the U.S.," said the study's senior author, Roy Richard Grinker, a professor of anthropology and international affairs at George Washington University.

The surprisingly large proportion of cases uncovered in ordinary schools, he noted, may in part reflect the low level of awareness and high degree of stigma attached to autism in South Korea. In addition, children with autism spectrum disorders may stand out less in South Korean schools, which follow highly structured and predictable routines and emphasize rote learning.

Other experts said that more "population based" studies, though costly, could help determine how broadly the Korean findings could be generalized to other societies.

Craig J. Newschaffer, chairman of epidemiology and biostatistics at the Drexel School of Public Health in Philadelphia, praised the new report, calling it "quite a strong study," but he added that the results were based on information about 63 percent of the schoolchildren, a good response rate but not ideal.

"It is just one area of Korea," he said, "and we know that there's random variation in how diseases are distributed."

A version of this article appeared in print on May 9, 2011, on page A4 of the New York edition with the headline: Research Uncovers Raised Rate Of Autism.


An 8 Year Specialist Follow-Up of a Supported Employment Service for High-Ability Adults With Autism or Asperger Syndrome

Patricia Howlin, St. George's Hospital Medical School, London, UK
Jennifer Alcock, Rotal Holloway University, London, UK
Catherine Burkin, National Autistic Society, London, UK
Sage Journals

Abstract

Few supported employment programmes have been specifically designed for people with autism, especially those who are more able. This study examines the outcome of a supported employment service (NAS Prospects) for adults with autism or Asperger syndrome (IQ 60+) over an 8 year period. Approximately 68 percent of clients found employment. Of the 192 jobs, the majority were permanent contracts and most involved administrative, technical or computing work. Assessment of current clients indicates that IQ, language skills and educational attainments are high. However, work has also been found for those of lower abilities. Individuals supported by Prospects show a rise in salaries, contribute more tax and claim fewer benefits. Satisfaction with the scheme is high among clients, employers and support workers. Although the programme continues to incur a financial deficit, this has decreased. Moreover, there are many non-financial benefits, which are difficult to quantify. The importance of specialist employment support of this kind is discussed.

Source: Autism: The International Journal of Research & Practice, Volume 9, Number 5, pages 533–549

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  • The Hayden Institute
  • AP 2008 Vaccine Case Won
  • Courts and Legislation
  • Landmark Vaccine-Autism Case

The Hayden Institute
www.haydeninstitute.com

Another Autism Case Wins in Vacinne Court
By Robert F. Kennedy, Jr.

On February 12, the federal "Vaccine Court" in Washington issued a sweeping ruling in three highly touted "test cases" against families who claimed that their childrens' autism had been caused by vaccines. The Special Masters in those three cases found that Petitioners failed to establish causation between MMR vaccines, the mercury-laced vaccine preservative thimerosal, and autism (the court decision, which is under appeal, deferred any finding on a thimerosal-only theory of causation). The rulings could have a significant precedential impact on some 5,000 families who opted to bring their cases in the Omnibus Autism Proceedings (OAP) hoping that the vaccine court would officially hold that the MMR vaccine or thimerosal had caused autism in their children.

The New York Times joined the government Health Agency (HRSA) and its big pharma allies hailing the decisions as proof that the scientific doubts about vaccine safety had finally been "demolished." The US Department of Health and Human services said the rulings should "help reassure parents that vaccines do not cause autism." The Times, which has made itself a blind mouthpiece for HRSA and a leading defender of vaccine safety, joined crowing government and vaccine industry flacks applauding the decisions like giddy cheerleaders, rooting for the same court that many of these same voices viscously derided just one year ago, after Hannah Poling won compensation for her vaccine induced autism.

But last week, the parents of yet another child with autism spectrum disorder (ASD) were awarded a lump sum of more than $810,000 (plus an estimated $30-40,000 per year for autism services and care) in compensation by the Court, which ruled that the measels-mumps-rubella (MMR) vaccine had caused acute brain damage that led to his autism spectrum disorder.

The family of 10-year-old Bailey Banks won their case quietly and without fanfare in June of 2007, but the ruling has only now come to public attention. In the remarkably clear and eloquent decision, Special Master Richard Abell ruled that the Banks had successfully demonstrated that "the MMR vaccine at issue actually caused the conditions from which Bailey suffered and continues to suffer."

Bailey's diagnosis is Pervasive Developmental Disorder -- Not Otherwise Specified (PDD-NOS) which has been recognized as an autism spectrum disorder by CDC, HRSA and the other federal health agencies since at least the 1990s.

In his conclusion, Special Master Abell ruled that Petitioners had proven that the MMR had directly caused a brain inflammation illness called acute disseminated encephalomyelitis (ADEM) which, in turn, had caused the autism spectrum disorder PDD-NOS in the child:

The Court found that Bailey's ADEM was both caused-in-fact and proximately caused by his vaccination. It is well-understood that the vaccination at issue can cause ADEM, and the Court found, based upon a full reading and hearing of the pertinent facts in this case, that it did actually cause the ADEM. Furthermore, Bailey's ADEM was severe enough to cause lasting, residual damage, and retarded his developmental progress, which fits under the generalized heading of Pervasive Developmental Delay, or PDD [an autism spectrum disorder]. The Court found that Bailey would not have suffered this delay but for the administration of the MMR vaccine, and that this chain of causation was... a proximate sequence of cause and effect leading inexorably from vaccination to Pervasive Developmental Delay.

The Bailey decision is not an isolated ruling. We now know of at least two other successful ADEM cases argued in Vaccine Court. More significantly, an explosive investigation by CBS News has found that since 1988, the vaccine court has awarded money judgments, often in the millions of dollars, to thirteen hundred and twenty two families whose children suffered brain damage from vaccines. In many of these cases, the government paid out awards following a judicial finding that vaccine injury lead to the child's autism spectrum disorder. In each of these cases, the plaintiffs' attorneys made the same tactical decision made by Bailey Bank's lawyer, electing to opt out of the highly charged Omnibus Autism Proceedings and argue their autism cases in the regular vaccine court. In many other successful cases, attorneys elected to steer clear of the hot button autism issue altogether and seek recovery instead for the underlying brain damage that caused their client's autism.

Medical records associated with these proceedings clearly tell the tale. In perhaps hundreds of these cases, the children have all the classic symptoms of regressive autism; following vaccination a perfectly healthy child experiences high fever, seizures, and other illnesses, then gradually, over about three months, loses language, the ability to make eye contact, becomes "over-focused" and engages in stereotypical head banging and screaming and then suffers developmental delays characteristic of autism. Many of these children had received the autism diagnosis. Yet the radioactive word "autism" appears nowhere in the decision.

Instead the vaccine court Special Masters rest their judgments on their finding that the vaccines caused some generalized brain injury, mainly Encephalopathy/encephalitis (brain inflammation) or "seizure disorders" -- conditions known to cause autism-like symptoms. A large number of the children who have won these judgments have been separately diagnosed with autism. HRSA acknowledged this fact in a recent letter, but told us it does not keep data on how many of these children were autistic.

The Vaccine Court, in other words, seems quite willing to award millions of dollars in taxpayer funded compensation to vaccine-injured autistic children, so long as they don't have to call the injury by the loaded term "autism." That hazard is particularly acute for vaccine victims who appear before the Omnibus Autism Proceedings (OAP). Since that body's decisions are closely watched, published and accorded the weight of precedent, many lawyers consider the burden of proof for petitioners to be impossibly high before the OAP Panel. It was for this reason that Bailey's attorney, Mark McLaren, elected to opt out of the OAP and try his case separately, even though Bailey has been receiving autism-related services in his home state and was eligible to file a case in the Court's Omnibus Autism Proceedings (OAP).

McLaren told us he wanted to avoid the added burden facing petitioners under the media glare and precedential weight attending OAP panel trials. "We considered [the OAP route] because [Bailey] is on the autistic spectrum of disorders, but we thought we could try it separately and apart from the Omnibus, and not as a test case," explained McLaren. "We thought we'd have a better chance if we tried to on its own merit, away from the spotlights and the precedent setting pressures that attend these OAP test cases - and it worked."

Bob Krakow, a leading attorney for vaccine damaged children told that many lawyers are now convinced that filing a claim in the OAP is a losing proposition. "There's a growing conviction that if you have a autistic client who has also been diagnosed with encephalopathy/encephalitis or seizure disorder, you are better off not mentioning the word "autism" if you want to win the case." He recommended instead filing a non autism claim like "mental retardation with seizure disorder" for an autistic client.

Although the vaccine court is mandated to fairly serve the victims of vaccine injuries, their primary purpose and raison d'etre is to protect the vaccine program and vaccine makers. Damages are doled out from a 75-cent tax on every vaccine sold and not from the vaccine makers. "You can understand why special masters, burdened with their duty to protect vaccine programs, might be unwilling to make the direct causal link between autism and vaccines," Krakow observed. "If you ask the big question and answer it in the affirmative, there is a sense that it will damage the vaccine program irreparably."

Vaccine Court judges are equipped with a draconian armory of weapons deployable against plaintiffs intent on proving the causal connection between vaccines and autism. Jury trials are prohibited. Damages are capped; awards for pain and suffering are strictly limited and punitive damages banned altogether. Vaccine defenders have an army of Department of Justice attorneys with virtually unlimited resources for expert witnesses and other litigation costs. Plaintiffs, in contrast, must fund the up front costs for experts on their own. In a cultural choice that clearly favors defendants, vaccine court gives overwhelming weight to written medical records which are often inaccurate -- over all other forms of testimony and evidence. Observations by parents and other caretakers are given little weight.

Worst of all -- plaintiffs have no right to discovery either against the pharmaceutical industry or the government. Since autism is a behavioral affliction rather than a precisely defined biological injury -- epidemiological studies are critical to establishing its causation. But the greatest source of epidemiological data is the Vaccine Safety Datalink (VSD) -- the government maintained medical records of hundreds of thousands of vaccinated children -- which HHS has gone to great lengths to keep out of the hands of plaintiffs' attorneys and independent scientists. Unfortunately the vaccine court has judicially anointed this corrupt concealment by consistently denying every motion by petitioners to view the VSD. The raw data collected in the VSD would undoubtedly provide the epidemiological evidence needed to understand the relationship between vaccines and autism. The absence of such studies makes it easy for judges to say to plaintiffs they have not met their burden of proving causation.

Meanwhile, CDC has actively, openly and systematically suppressed and defunded epidemiological studies that might establish a causal link. CDC has ignored repeated pleadings that it fund peer reviewed studies of unvaccinated American cohorts like the Amish and home-schooled children. At the same time the agency has worked overtime ginning up a series of fatally-flawed European studies purporting to dispute the link. Even a cursory critical examination reveals that the oft-cited Danish, English, and Italian studies are rank tobacco science. Many of them were funded by CDC, a badly compromised agency, performed by vaccine industry scientists, and published in miserably conflicted journals.

Needless to say, the existence of these phony studies, combined with the deliberate dearth of epidemiological evidence makes it easy for the special masters to dodge a politically explosive finding by holding that there is "insufficient evidence."

And, speaking of tobacco, it's worth recalling that for sixty years the tobacco industry successfully defended a product that was killing one out of every five of its customers against thousands of legal actions brought by its victims and their families. Tobacco lawyers protected the cigarette companies by arguing that there was no proven link between tobacco and lung cancer. Bob Krakow sees many parallels. Big tobacco uses the same tactic of manufacturing research that seems to dispute the connection to exploit the burdens on plaintiffs to prove causation. Big tobacco prevailed for six decades even without the help of supportive government agencies deliberately suppressing real science and research. In that sense vaccine victims must leap a much higher hurdle.

Despite the perilous odds stacked against them in vaccine court, the evidence of a vaccine/autism link is so strong that vaccine court judges and government agencies have now recognized at least two theories of how vaccines cause autism: the Vaccine-to-ADEM-to-ASD link in Bailey Banks' case, and vaccine-induced aggravation of an underlying mitochondrial dysfunction that caused full-blown autism in the Hannah Poling case. Both theories are different from those rejected in the three cases last week.

Perhaps, these new disclosures will prompt The Times, with all its influence, to actually make prudent journalistic inquiries into the phony science CDC uses to defend its claims of "vaccine safety." If it does, the paper will realize it has once again been ill used by government agencies in a tragic campaign of public deceit. The Times should make the reasonable demand that the government health agencies finally release the Vaccine Safety Datalink for independent scientific research and that CDC and HRSA lift their opposition to genuine epidemiological studies that might finally provide real scientific answers to this debate.

AP 2008 Vaccine Case Won
Family at Center of Vaccine-Autism Case Speaks

Description: http://msnbcmedia3.msn.com/i/msnbc/Components/Sources/sourceAP.gif

updated 3/6/2008 7:42:29 PM ET
ATLANTA — The parents of a girl who won a government settlement described how their hearts were broken as they watched their healthy, red-haired toddler transformed into an irritable, odd-behaving child after she got several childhood shots.

“Suddenly my daughter was no longer there,” said Terry Poling, the girl’s mother, in a news conference Thursday. She and her husband Jon said their daughter Hannah, now 9, has been diagnosed with autism.



The government has agreed to pay the Polings from a federal fund that compensates people injured by vaccines. The amount of the settlement hasn’t been set yet. U.S. officials reject the idea that vaccines cause autism, but they say that in this case the shots worsened an underlying disorder that led to autism-like symptoms.

The Polings said five simultaneous vaccinations in July 2000 led to Hannah’s autistic behavior. She was about 18 months at the time.

U.S. health officials have consistently maintained that vaccines are safe, and the head of the Centers for Disease Control and Prevention said Thursday that there was no change in that position.

“Nothing in any of this is going to change any of our recommendations” about the importance of vaccines for children, said Dr. Julie Gerberding. “Our message to parents is that immunization is lifesaving.”

In the Polings’ first appearance since their case became public this week, the Athens, Ga., couple acknowledged their legal case never got to the point where evidence was argued.

They called on the government to remove thimerosal — a mercury-based vaccine preservative — from all flu shots. Thimerosal has already been removed from other vaccinations given to children.

“Why take a chance?” asked Jon Poling, a 37-year-old neurologist.

The Polings, accompanied by Hannah, said that as a toddler, their daughter was a bright child who could whistle on command. But almost immediately after the vaccinations nearly eight years ago, she became feverish and irritable. Then, her behavior gradually changed so she would stare at fans and lights and run in circles.

“It wasn’t like a switch being turned off. It was more like a dimmer switch being turned down,” Jon Poling said.

Government health officials conceded that the vaccines exacerbated an underlying condition and that she should be paid from the federal vaccine-injury fund.

Autism advocates called Hannah’s case a “landmark decision,” although the Polings’ own attorney disputes that.

“This was not a court decision,” said Clifford Shoemaker, who is based in Vienna, Va. The U.S. Department of Health and Human Services conceded the case before the court was asked to make a determination, he added.

Government officials wouldn’t discuss why they conceded this particular case, but said people with pre-existing injuries can obtain compensation under the program if they establish that their underlying condition was “significantly aggravated” by a vaccine.

Medical and legal experts say the narrow wording and circumstances probably make the case an exception — not a precedent for thousands of other pending claims.

“This does not represent anything other than a very special situation,” said the CDC’s Gerberding.

Hannah has a disorder involving her mitochondria, the energy factories of cells. The disorder — which can be present at birth from an inherited gene or acquired later in life — impairs cells’ ability to use nutrients. It often causes problems in brain functioning and can lead to delays in walking and talking.

Experts argued over how common the disorder is, and by implication, how many other vaccine cases might be affected.Description: http://hs.interpolls.com/imprimage.poll?a=69411&c=3025&p=1&t=9&i=0&rnd=92483243633208140

“Most children with autism do not seem to have a mitochondrial problem, so this association ... is probably relatively rare,” said Dr. Edwin Trevathan, a pediatric neurologist who heads the CDC’s birth defects center.

The United Mitochondrial Disease Foundation, a Pittsburgh-based group that raises money for research, says there are more than 100 types of mitochondrial disease, and genetic tests can find only a couple dozen.

The Polings were exploring two theories about what happened to Hannah. One is that she was born with the mitochondria disorder and the vaccines caused a stress to the body that worsened the condition. The other was that the ingredient thimerosal caused the mitochondrial dysfunction, Jon Poling said.

Since 2002, the preservative thimerosal has been removed from shots recommended for young children, except for some flu shots.

Courts and Legislation Effects on Educational Funding

New California legislation that effects funding would have to be the classroom size cap.  Under the class size reduction program, participating school districts are provided funding for each class in which the class size is reduced to a ratio of 20 pupils to one teacher in kindergarten and any of grades 1 to 3, inclusive. Until July 1, 2009, this bill requires the Controller to deduct from the next principal apportionment of the district a specified amount based on the annual pupil enrollment of a class above a different prescribed number. The bill also provides relief for the counties of Los Angeles, Riverside, San Bernardino, San Diego, and Ventura that suffered a loss of state funding as a result of the fires that occurred in October 2003.

One of the most controversial federal statues would have to be the “No Child Left Behind  No Child Left behind Act is expected to better target resources to school districts with high concentrations of poor children. The law also includes provisions intended to give states and districts greater flexibility in how they spend a portion of their federal allotments. Unfortunately in California many have felt that federal support for the law is not commensurate with its demands and that compliance may place undue financial burdens on states and schools.  A recent study Policy Analysis for California suggests that, because of its requirement to evaluate school progress on the basis of demographic subgroups, the law may disproportionately penalize schools with diverse student populations (Public Agenda, 2003; Policy Analysis for California Education, 2003).

The Eliezer Williams, et al., vs. State of California, et al. (Williams) case was filed as a class action in 2000 in San Francisco County Superior Court. The plaintiffs include nearly 100 San Francisco County students, who filed suit against the State of California and state education agencies, including the California Department of Education. The basis of the lawsuit was that the agencies failed to provide public school students with equal access to instructional materials, safe and decent school facilities, and qualified teachers. The case was settled in 2004, resulting in the state allocating $138 million in additional funding for standards-aligned instructional materials for schools in the first and second ranks (known as deciles) determined through the 2003 academic performance index.

The overall effects of this case on my school district have sparked proposed changes to the school accountability report card.  Schools must update and publish annul reports of all resources.  The proposed changes will help all schools report the overall condition of their facilities, the number of teacher mis-assignments and vacant teacher positions, and the availability of textbooks or instructional materials.  With adequate resources, school annual reports, and administrative review our school has seen better performance from students and teachers.
Resources

(Public Agenda, 2003; Policy Analysis for California Education, 2003).

U.S. Agrees to Pay $1.5 Million in Landmark Vaccine-Autism Case
http://www.fairwarning.org/2010/09/u-s-agrees-to-pay-1-5-million-in-landmark-vaccine-autism-case
By Patrick Corcoran on September 10, 2010
See Correction Below*

The federal government has agreed to pay $1.5 million to the family of an autistic girl, marking the first award of compensation in a vaccine-autism case, CBS News Reports.

The case involves Hannah Poling, now 11, of Athens, Ga. — described by her family as a normal toddler who regressed into autism after receiving vaccinations for nine different diseases in a single doctor’s visit in 2000.

In 2002, her parents filed a claim with the federal Vaccine Injury Compensation Program, a branch of the U.S. Court of Federal Claims. Under federal law, injury claims involving routinely administered vaccines are filed there rather than in the civil courts.

The government agreed to settle five years later, acknowledging that Hannah’s autism coincided with her receiving the vaccines, but not conceding that they caused her condition. It’s taken two years to reach an agreement on the amount of compensation.

No claim that a child’s autism was caused by vaccinations has ever won in trial. There are nearly 5,000 autism cases currently pending in vaccine court.

There have long been worries about connections between vaccinations and autism, though most experts say that credible studies have debunked a causal link.

*Our post on compensation for the family of a child who developed symptoms of autism after getting vaccinated against nine diseases on a single day understated the amount of the award. Hannah Poling and her family are to receive a lump sum of nearly $1.52 million, along with payments of more than $500,000 per year for Hannah’s medical care and living expenses. According to evidence in the case, Hannah had an underlying genetic condition, mitochondrial disorder, that may have predisposed her to regressing into autism when her body was overwhelmed by five vaccinations on a single visit.

  • Individual Bills
  • SB 988 Attorney Education 02.01.12
  • SB 964 Passed

Commission on Teacher Credentialing

Education Specialist Teaching and Other Related Services Credential Program Standards
Adopted by the Commission, December 2008-January 2010

PDF Document

Autism Insurance Mandate Bill

Overview & Background
SB 946 (Steinberg)

PDF Document

I.D.E.A. Individuals with Disabilities Education Act 2004

http://www2.ed.gov/policy/speced/guid/idea/idea2004.html
http://www.fape.org/idea/2004/summary.htm


The IDEA 2004 Law

Provides all laws regarding the IEP and Parents rights to create long & short term educational goal for their children with disabilities. http://www2.ed.gov/policy/speced/leg/edpicks.jhtml?src=ln

National Center for Education Statistics

http://nces.ed.gov
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=108_cong_public_laws&docid=f:publ446.108

[[Page 118 STAT. 2647]]

Public Law 108-446
108th Congress

An Act

To reauthorize the Individuals with Disabilities Education Act, and for
other purposes. <<NOTE: Dec. 3, 2004 - [H.R. 1350]>>

Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled, <<NOTE: Individuals with
Disabilities Education Improvement Act of 2004. 20 USC 1400 note.>>

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Individuals with Disabilities
Education Improvement Act of 2004''.

SEC. 2. ORGANIZATION OF THE ACT.

This Act is organized into the following titles:
Title I--Amendments to the Individuals With Disabilities
Education Act.
Title II--National Center for Special Education Research.
Title III--Miscellaneous Provisions.

TITLE I--AMENDMENTS TO THE INDIVIDUALS WITH DISABILITIES EDUCATION ACT

SEC. 101. AMENDMENTS TO THE INDIVIDUALS WITH DISABILITIES EDUCATION ACT.

Parts A through D of the Individuals with Disabilities Education Act
(20 U.S.C. 1400 et seq.) are amended to read as follows:

``PART A--GENERAL PROVISIONS (CONTINUES)

SEE MORE (MUCH!!)
http://www2.ed.gov/policy/speced/leg/edpicks.jhtml?src=ln

Bill Number:
SB 988 Introduced Bill Text

Introduced by Senator Liu
FEBRUARY 1, 2012
An act to add Section 634.3 to the Welfare and Institutions Code, relating to attorneys.

Legislative Counsel's Digest

SB 988, as introduced, Liu. Wards: attorney qualifications. Existing law provides that any person under 18 years of age who commits a crime is within the jurisdiction of the uvenile court, except as specified. Existing law further provides that a minor has the right to counsel in proceedings to declare the minor a ward of the court. If the minor and his or her parents are indigent, the minor is entitled to appointed counsel.

This bill would specify that all minors who are represented by counsel in wardship proceedings are entitled to competent counsel, as defined. Further, this bill would set forth mandatory training and education standards for attorneys representing minors in wardship proceedings. Under this bill, an attorney would be solely responsible for fulfilling these requirements. An attorney would also be responsible for meeting regularly with his or her client, as well ascontacting professionals associated with the client's case, working with other counsel and the court to resolve the case without a contested hearing, and adhering to mandated timelines. By increasing the duties of these attorneys, including public defenders, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

The People of the State of California Do Enact as Follows:

SECTION 1.  Section 634.3 is added to the Welfare and Institutions Code, to read:

634.3.  (a) The Legislature finds and declares the following:

(1) As representing children in the juvenile justice system, particularly in delinquency court, has become much more complex than the practice was a generation ago, there is a greater need for education, training, and resources in this specialized discipline.

(2) Problems in preparation and representation by attorneys at early stages in the adjudicatory process often result in harmful or less favorable outcomes for children at and after disposition.

(3) Not only are dependency attorneys required to meet mandatory minimum training and education requirements to certify that they are qualified to represent children in dependency proceedings, but all stakeholders in dependency court are required to meet mandatory minimum education and training requirements and standards of practice before working in dependency court and on a continuing basis.

(4) It is incumbent that California's juvenile delinquency attorneys have the appropriate skill set to meet demands of this growing complex area of legal practice.

(b) For purposes of this section, "competent counsel" means an attorney who meets all of the following criteria:

(1) Is a member in good standing of the State Bar of California.

(2) Has participated in training in juvenile law for proceedings under Sections 601 and 602 as required by subdivision (d).

(3) Demonstrates adequate forensic skills, knowledge, and comprehension of the statutory scheme, the purposes and goals of proceedings under Sections 601 and 602, the specific statutes, the rules of court, and cases relevant to those proceedings, and procedures for filing law and motion matters in juvenile court.

(c) Every minor in a proceeding under Section 601 or 602 who is represented by an attorney is entitled to competent counsel.

(d) Only attorneys who have completed a minimum of eight hours of training or education in the area of wardship proceedings may be appointed to represent minors in juvenile court under Sections 601 and 602. Attorneys must complete at least eight hours of education every three years related to proceedings under Sections 601 and 602. In addition to a summary of wardship law and related statutes and cases, training and education for attorneys must include information on child development, special education, mental health issues, child abuse and neglect, substance abuse, domestic violence, and family reunification and preservation.

(e) An attorney shall be solely responsible for fulfilling the training and education requirements. The attorney's employer shall not be responsible for the training of attorneys and may hire attorneys that have not been trained.

(f) Attorneys or their agents shall meet regularly with clients, regardless of the child's age or ability to communicate verbally. The attorney for the child must have sufficient contact with the child to establish and maintain an adequate and professional attorney-client relationship.

(g) Attorneys or their agents shall contact social workers, probation officers, or other professionals associated with the client' s case, work with other counsel and the court to resolve disputed aspects of a case without a contested hearing, and adhere to the mandated timelines. The attorney for the child is not required to assume the responsibilities of a social worker or to perform services for the child that are unrelated to the child's legal representation.

SEC. 2.  If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.

BILL NUMBER: SB 946 ENROLLED

PASSED THE SENATE SEPTEMBER 9, 2011
PASSED THE ASSEMBLY SEPTEMBER 9, 2011
AMENDED IN ASSEMBLY SEPTEMBER 9, 2011
AMENDED IN ASSEMBLY SEPTEMBER 6, 2011
AMENDED IN ASSEMBLY SEPTEMBER 2, 2011
AMENDED IN SENATE MAY 10, 2011

INTRODUCED BY Senators Steinberg and Evans
(Principal coauthor: Senator Alquist)
(Principal coauthor: Assembly Member Beall)
(Coauthors: Senators Corbett, DeSaulnier, Leno, Lieu, Liu, Padilla, Pavley, and Wolk)
(Coauthors: Assembly Members Ammiano, Butler, Dickinson, Eng, Fong, Mitchell, Portantino, Williams, and Yamada)

MARCH 31, 2011

An act to amend Section 121022 of, to add Section 1374.74 to, and to add and repeal Section 1374.73 of, the Health and Safety Code, to add and repeal Sections 10144.51 and 10144.52 of the Insurance Code, and to amend Sections 5705, 5708, 5710, 5716, 5724, and 5750.1 of the Welfare and Institutions Code, relating to health.

LEGISLATIVE COUNSEL'S DIGEST

SB 946, Steinberg. Health care coverage: mental illness: pervasive developmental disorder or autism: public health.

Existing law provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. A willful violation of these provisions is a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plan contracts and health insurance policies to provide benefits for specified conditions, including certain mental health conditions.

This bill, effective July 1, 2012, would require those health care service plan contracts and health insurance policies, except as specified, to provide coverage for behavioral health treatment, as defined, for pervasive developmental disorder or autism. The bill would provide, however, that no benefits are required to be provided that exceed the essential health benefits that will be required under specified federal law. Because a violation of these provisions with respect to health care service plans would be a crime, the bill would impose a state-mandated local program.

These provisions would be inoperative July 1, 2014, and repealed on January 1, 2015.

The bill would require the Department of Managed Health Care, in conjunction with the Department of Insurance, to convene an Autism Advisory Task Force by February 1, 2012, to provide assistance to the department on topics related to behavioral health treatment and to develop recommendations relating to the education, training, and experience requirements to secure licensure from the state. The bill would require the department to submit a report of the Task Force to the Governor and specified members of the Legislature by December 31, 2012.

Existing law establishes various communicable disease prevention and control programs. Existing law requires the State Department of Public Health to establish a list of reportable diseases and conditions and requires health care providers and laboratories to report cases of HIV infection to the local health officer using patient names and sets guidelines regarding these reports. Existing law requires the local health officers to report unduplicated HIV cases by name to the department.

This bill would authorize the department to revise the HIV reporting form without the adoption of a regulation, as specified.

Under the Bronzan-McCorquodale Act, the State Department of Mental Health administers the provision of funds to counties for community mental health services programs. Existing law also permits counties to receive, under certain circumstances, Medi-Cal reimbursement for mental health services. Under existing law, negotiated net amounts or rates are used as the cost of services in contracts between the state and the county and between the county and a subprovider of services. Existing law establishes the method for computing negotiated rates. Existing law prohibits the charges for the care and treatment of each patient receiving service from a county mental health program from exceeding the actual or negotiated cost of the services.

This bill would only allow the use of negotiated net amounts as the cost of services in a contract between the state and a county and the county and a subprovider of services, and would eliminate the use of negotiated rates. The bill would also specify that the charges for the care and treatment of each patient receiving a service from a county mental health program shall not exceed the actual cost of the service.

Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which basic health care services are provided to qualified low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Under existing law, the State Department of Health Care Services promulgates regulations for determining reimbursement of Short-Doyle mental health services allowable under the Medi-Cal program. Existing law requires the State Department of Mental Health and the State Department of Health Care Services to jointly develop a ratesetting methodology for use in the Short-Doyle Medi-Cal system that maximizes federal funding and utilizes, as much as practicable, federal Medicare reimbursement principles. Existing law requires that this ratesetting methodology contain incentives relating to economy and efficiency.

The bill would delete the requirement that the ratesetting methodology in the Short-Doyle Medi-Cal system include incentives relating to economy and efficiency.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

SECTION 1. Section 1374.73 is added to the Health and Safety Code, to read:

1374.73. (a) (1) Every health care service plan contract that provides hospital, medical, or surgical coverage shall also provide coverage for behavioral health treatment for pervasive developmental disorder or autism no later than July 1, 2012. The coverage shall be provided in the same manner and shall be subject to the same requirements as provided in Section 1374.72.

(2) Notwithstanding paragraph (1), as of the date that proposed final rulemaking for essential health benefits is issued, this section does not require any benefits to be provided that exceed the essential health benefits that all health plans will be required by federal regulations to provide under Section 1302(b) of the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152).

(3) This section shall not affect services for which an individual is eligible pursuant to Division 4.5 (commencing with Section 4500) of the Welfare and Institutions Code or Title 14 (commencing with Section 95000) of the Government Code.

(4) This section shall not affect or reduce any obligation to provide services under an individualized education program, as defined in Section 56032 of the Education Code, or an individualized service plan, as described in Section 5600.4 of the Welfare and Institutions Code, or under the Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400, et seq.) and its implementing regulations.

(b) Every health care service plan subject to this section shall maintain an adequate network that includes qualified autism service providers who supervise and employ qualified autism service professionals or paraprofessionals who provide and administer behavioral health treatment. Nothing shall prevent a health care service plan from selectively contracting with providers within these requirements.

(c) For the purposes of this section, the following definitions shall apply:

(1) "Behavioral health treatment" means professional services and treatment programs, including applied behavior analysis and evidence-based behavior intervention programs, that develop or restore, to the maximum extent practicable, the functioning of an individual with pervasive developmental disorder or autism and that meet all of the following criteria:

(A) The treatment is prescribed by a physician and surgeon licensed pursuant to Chapter 5 (commencing with Section 2000) of, or is developed by a psychologist licensed pursuant to Chapter 6.6 (commencing with Section 2900) of, Division 2 of the Business and Professions Code.

(B) The treatment is provided under a treatment plan prescribed by a qualified autism service provider and is administered by one of the following:

(i) A qualified autism service provider.

(ii) A qualified autism service professional supervised and employed by the qualified autism service provider.

(iii) A qualified autism service paraprofessional supervised and employed by a qualified autism service provider.

(C) The treatment plan has measurable goals over a specific timeline that is developed and approved by the qualified autism service provider for the specific patient being treated. The treatment plan shall be reviewed no less than once every six months by the qualified autism service provider and modified whenever appropriate, and shall be consistent with Section 4686.2 of the Welfare and Institutions Code pursuant to which the qualified autism service provider does all of the following:

(i) Describes the patient's behavioral health impairments to be treated.

(ii) Designs an intervention plan that includes the service type, number of hours, and parent participation needed to achieve the plan's goal and objectives, and the frequency at which the patient's progress is evaluated and reported.

(iii) Provides intervention plans that utilize evidence-based practices, with demonstrated clinical efficacy in treating pervasive developmental disorder or autism.

(iv) Discontinues intensive behavioral intervention services when the treatment goals and objectives are achieved or no longer appropriate.

(D) The treatment plan is not used for purposes of providing or for the reimbursement of respite, day care, or educational services and is not used to reimburse a parent for participating in the treatment program. The treatment plan shall be made available to the health care service plan upon request.

(2) "Pervasive developmental disorder or autism" shall have the same meaning and interpretation as used in Section 1374.72.

(3) "Qualified autism service provider" means either of the following:

(A) A person, entity, or group that is certified by a national entity, such as the Behavior Analyst Certification Board, that is accredited by the National Commission for Certifying Agencies, and who designs, supervises, or provides treatment for pervasive developmental disorder or autism, provided the services are within the experience and competence of the person, entity, or group that is nationally certified.

(B) A person licensed as a physician and surgeon, physical therapist, occupational therapist, psychologist, marriage and family therapist, educational psychologist, clinical social worker, professional clinical counselor, speech-language pathologist, or audiologist pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, who designs, supervises, or provides treatment for pervasive developmental disorder or autism, provided the services are within the experience and competence of the licensee.

(4) "Qualified autism service professional" means an individual who meets all of the following criteria:

(A) Provides behavioral health treatment.

(B) Is employed and supervised by a qualified autism service provider.

(C) Provides treatment pursuant to a treatment plan developed and approved by the qualified autism service provider.

(D) Is a behavioral service provider approved as a vendor by a California regional center to provide services as an Associate Behavior Analyst, Behavior Analyst, Behavior Management Assistant, Behavior Management Consultant, or Behavior Management Program as defined in Section 54342 of Title 17 of the California Code of Regulations.

(E) Has training and experience in providing services for pervasive developmental disorder or autism pursuant to Division 4.5 (commencing with Section 4500) of the Welfare and Institutions Code or Title 14 (commencing with Section 95000) of the Government Code.

(5) "Qualified autism service paraprofessional" means an unlicensed and uncertified individual who meets all of the following criteria:

(A) Is employed and supervised by a qualified autism service provider.

(B) Provides treatment and implements services pursuant to a treatment plan developed and approved by the qualified autism service provider.

(C) Meets the criteria set forth in the regulations adopted pursuant to Section 4686.3 of the Welfare and Institutions Code.

(D) Has adequate education, training, and experience, as certified by a qualified autism service provider.

(d) This section shall not apply to the following:

(1) A specialized health care service plan that does not deliver mental health or behavioral health services to enrollees.

(2) A health care service plan contract in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code).

(3) A health care service plan contract in the Healthy Families Program (Part 6.2 (commencing with Section 12693) of Division 2 of the Insurance Code).

(4) A health care benefit plan or contract entered into with the Board of Administration of the Public Employees' Retirement System
pursuant to the Public Employees' Medical and Hospital Care Act (Part 5 (commencing with Section 22750) of Division 5 of Title 2 of the Government Code).

(e) Nothing in this section shall be construed to limit the obligation to provide services under Section 1374.72.

(f) As provided in Section 1374.72 and in paragraph (1) of subdivision (a), in the provision of benefits required by this section, a health care service plan may utilize case management, network providers, utilization review techniques, prior authorization, copayments, or other cost sharing.

(g) This section shall become inoperative on July 1, 2014, and, as of January 1, 2015, is repealed, unless a later enacted statute, that becomes operative on or before January 1, 2015, deletes or extends the dates on which it becomes inoperative and is repealed.

SEC. 2. Section 1374.74 is added to the Health and Safety Code, to read:

1374.74. (a) The department, in consultation with the Department of Insurance, shall convene an Autism Advisory Task Force by February 1, 2012, in collaboration with other agencies, departments, advocates, autism experts, health plan and health insurer representatives, and other entities and stakeholders that it deems appropriate. The Autism Advisory Task Force shall develop recommendations regarding behavioral health treatment that is medically necessary for the treatment of individuals with autism or pervasive developmental disorder. The Autism Advisory Task Force shall address at the following:

(1) Interventions that have been scientifically validated and have demonstrated clinical efficacy.

(2) Interventions that have measurable treatment outcomes.

(3) Patient selection, monitoring, and duration of therapy.

(4) Qualifications, training, and supervision of providers.

(5) Adequate networks of providers.

(b) The Autism Advisory Task Force shall also develop recommendations regarding the education, training, and experience requirements that unlicensed individuals providing autism services shall meet in order to secure a license from the state.

(c) The department shall submit a report of the Autism Advisory Task Force to the Governor, the President pro Tempore of the Senate, the Speaker of the Assembly, and the Senate and Assembly Committees on Health by December 31, 2012, on which date the task force shall cease to exist.

SEC. 3. Section 121022 of the Health and Safety Code is amended to read:

121022. (a) To ensure knowledge of current trends in the HIV epidemic and to ensure that California remains competitive for federal HIV and AIDS funding, health care providers and laboratories shall report cases of HIV infection to the local health officer using patient names on a form developed by the department. Local health officers shall report unduplicated HIV cases by name to the department on a form developed by the department.

(b) (1) Health care providers and local health officers shall submit cases of HIV infection pursuant to subdivision (a) by courier service, United States Postal Service express mail or registered mail, other traceable mail, person-to-person transfer, facsimile, or electronically by a secure and confidential electronic reporting system established by the department.

(2) This subdivision shall be implemented using the existing resources of the department.

(c) The department and local health officers shall ensure continued reasonable access to anonymous HIV testing through alternative testing sites, as established by Section 120890, and in consultation with HIV planning groups and affected stakeholders, including representatives of persons living with HIV and health officers.

(d) The department shall promulgate emergency regulations to conform the relevant provisions of Article 3.5 (commencing with Section 2641.5) of Chapter 4 of Division 1 of Title 17 of the California Code of Regulations, consistent with this chapter, by April 17, 2007. Notwithstanding the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), if the department revises the form used for reporting pursuant to subdivision (a) after consideration of the reporting guidelines published by the federal Centers for Disease Control and Prevention, the revised form shall be implemented without being adopted as a regulation, and shall be filed with the Secretary of State and printed in Title 17 of the California Code of Regulations.

(e) Pursuant to Section 121025, reported cases of HIV infection shall not be disclosed, discoverable, or compelled to be produced in any civil, criminal, administrative, or other proceeding.

(f) State and local health department employees and contractors shall be required to sign confidentiality agreements developed by the department that include information related to the penalties for a breach of confidentiality and the procedures for reporting a breach of confidentiality, prior to accessing confidential HIV-related public health records. Those agreements shall be reviewed annually by either the department or the appropriate local health department.

(g) No person shall disclose identifying information reported pursuant to subdivision (a) to the federal government, including, but not limited to, any agency, employee, agent, contractor, or anyone else acting on behalf of the federal government, except as permitted under subdivision (b) of Section 121025.

(h) (1) Any potential or actual breach of confidentiality of HIV-related public health records shall be investigated by the local health officer, in coordination with the department, when appropriate. The local health officer shall immediately report any evidence of an actual breach of confidentiality of HIV-related public health records at a city or county level to the department and the appropriate law enforcement agency.

(2) The department shall investigate any potential or actual breach of confidentiality of HIV-related public health records at the state level, and shall report any evidence of such a breach of confidentiality to an appropriate law enforcement agency. (i) Any willful, negligent, or malicious disclosure of cases of HIV infection reported pursuant to subdivision (a) shall be subject to the penalties prescribed in Section 121025.

(j) Nothing in this section shall be construed to limit other remedies and protections available under state or federal law.

SEC. 4. Section 10144.51 is added to the Insurance Code, to read:

10144.51. (a) (1) Every health insurance policy shall also provide coverage for behavioral health treatment for pervasive developmental disorder or autism no later than July 1, 2012. The coverage shall be provided in the same manner and shall be subject to the same requirements as provided in Section 10144.5.

(2) Notwithstanding paragraph (1), as of the date that proposed final rulemaking for essential health benefits is issued, this section does not require any benefits to be provided that exceed the essential health benefits that all health insurers will be required by federal regulations to provide under Section 1302(b) of the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152).

(3) This section shall not affect services for which an individual is eligible pursuant to Division 4.5 (commencing with Section 4500) of the Welfare and Institutions Code or Title 14 (commencing with Section 95000) of the Government Code.

(4) This section shall not affect or reduce any obligation to provide services under an individualized education program, as defined in Section 56032 of the Education Code, or an individualized service plan, as described in Section 5600.4 of the Welfare and Institutions Code, or under the Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400, et seq.) and its implementing regulations.

(b) Pursuant to Article 6 (commencing with Section 2240.1) of Title 10 of the California Code of Regulations, every health insurer subject to this section shall maintain an adequate network that includes qualified autism service providers who supervise and employ qualified autism service professionals or paraprofessionals who provide and administer behavioral health treatment. Nothing shall prevent a health insurer from selectively contracting with providers within these requirements.

(c) For the purposes of this section, the following definitions shall apply:

(1) "Behavioral health treatment" means professional services andtreatment programs, including applied behavior analysis and evidence-based behavior intervention programs, that develop or restore, to the maximum extent practicable, the functioning of an individual with pervasive developmental disorder or autism, and that meet all of the following criteria:

(A) The treatment is prescribed by a physician and surgeon licensed pursuant to Chapter 5 (commencing with Section 2000) of, or is developed by a psychologist licensed pursuant to Chapter 6.6 (commencing with Section 2900) of, Division 2 of the Business and Professions Code.

(B) The treatment is provided under a treatment plan prescribed by a qualified autism service provider and is administered by one of the following:

(i) A qualified autism service provider.

(ii) A qualified autism service professional supervised and employed by the qualified autism service provider.

(iii) A qualified autism service paraprofessional supervised and employed by a qualified autism service provider.

(C) The treatment plan has measurable goals over a specific timeline that is developed and approved by the qualified autism service provider for the specific patient being treated. The treatment plan shall be reviewed no less than once every six months by the qualified autism service provider and modified whenever appropriate, and shall be consistent with Section 4686.2 of the Welfare and Institutions Code pursuant to which the qualified autism service provider does all of the following:

(i) Describes the patient's behavioral health impairments to be treated.

(ii) Designs an intervention plan that includes the service type, number of hours, and parent participation needed to achieve the plan' s goal and objectives, and the frequency at which the patient's progress is evaluated and reported.

(iii) Provides intervention plans that utilize evidence-based practices, with demonstrated clinical efficacy in treating pervasive developmental disorder or autism.

(iv) Discontinues intensive behavioral intervention services when the treatment goals and objectives are achieved or no longer appropriate.

(D) The treatment plan is not used for purposes of providing or for the reimbursement of respite, day care, or educational services and is not used to reimburse a parent for participating in the treatment program. The treatment plan shall be made available to the insurer upon request.

(2) "Pervasive developmental disorder or autism" shall have the same meaning and interpretation as used in Section 10144.5.

(3) "Qualified autism service provider" means either of the following:

(A) A person, entity, or group that is certified by a national entity, such as the Behavior Analyst Certification Board, that is accredited by the National Commission for Certifying Agencies, and who designs, supervises, or provides treatment for pervasive developmental disorder or autism, provided the services are within the experience and competence of the person, entity, or group that is nationally certified.

(B) A person licensed as a physician and surgeon, physical therapist, occupational therapist, psychologist, marriage and family therapist, educational psychologist, clinical social worker, professional clinical counselor, speech-language pathologist, or audiologist pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, who designs, supervises, or provides treatment for pervasive developmental disorder or autism, provided the services are within the experience and competence of the licensee.

(4) "Qualified autism service professional" means an individual who meets all of the following criteria:

(A) Provides behavioral health treatment.

(B) Is employed and supervised by a qualified autism service provider.

(C) Provides treatment pursuant to a treatment plan developed and approved by the qualified autism service provider.

(D) Is a behavioral service provider approved as a vendor by a California regional center to provide services as an Associate Behavior Analyst, Behavior Analyst, Behavior Management Assistant, Behavior Management Consultant, or Behavior Management Program as defined in Section 54342 of Title 17 of the California Code of Regulations.

(E) Has training and experience in providing services for pervasive developmental disorder or autism pursuant to Division 4.5 (commencing with Section 4500) of the Welfare and Institutions Code or Title 14 (commencing with Section 95000) of the Government Code.

(5) "Qualified autism service paraprofessional" means an unlicensed and uncertified individual who meets all of the following criteria:

(A) Is employed and supervised by a qualified autism service provider.

(B) Provides treatment and implements services pursuant to a treatment plan developed and approved by the qualified autism service provider.

(C) Meets the criteria set forth in the regulations adopted pursuant to Section 4686.3 of the Welfare and Institutions Code.

(D) Has adequate education, training, and experience, as certified by a qualified autism service provider. (d) This section shall not apply to the following:

(1) A specialized health insurance policy that does not cover mental health or behavioral health services or an accident only, specified disease, hospital indemnity, or Medicare supplement policy.

(2) A health insurance policy in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code).

(3) A health insurance policy in the Healthy Families Program (Part 6.2 (commencing with Section 12693) of Division 2 of the Insurance Code).

(4) A health care benefit plan or policy entered into with the Board of Administration of the Public Employees' Retirement System pursuant to the Public Employees' Medical and Hospital Care Act (Part 5 (commencing with Section 22750) of Division 5 of Title 2 of the Government Code).

(e) Nothing in this section shall be construed to limit the obligation to provide services under Section 10144.5.

(f) As provided in Section 10144.5 and in paragraph (1) of subdivision (a), in the provision of benefits required by this section, a health insurer may utilize case management, network providers, utilization review techniques, prior authorization, copayments, or other cost sharing.

(g) This section shall become inoperative on July 1, 2014, and, as of January 1, 2015, is repealed, unless a later enacted statute, that becomes operative on or before January 1, 2015, deletes or extends the dates on which it becomes inoperative and is repealed.

SEC. 5. Section 10144.52 is added to the Insurance Code, to read:

10144.52. (a) For purposes of this part, the terms "provider," "professional provider," "network provider," "mental health provider," and "mental health professional" shall include the term "qualified autism service provider," as defined in subdivision (c) of Section
10144.51.

(b) This section shall become inoperative on July 1, 2014, and, as of January 1, 2015, is repealed, unless a later enacted statute, that becomes operative on or before January 1, 2015, deletes or extends the dates on which it becomes inoperative and is repealed.

SEC. 6. Section 5705 of the Welfare and Institutions Code is amended to read:

(a) It is the intent of the Legislature that the use of negotiated net amounts, as provided in this section, be given preference in contracts for services under this division.

(b) Negotiated net amounts may be used as the cost of services in contracts between the state and the county or contracts between the county and a subprovider of services, or both. A negotiated net amount shall be determined by calculating the total budget for services for a program or a component of a program, less the amount of projected revenue. All participating government funding sources, except for the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9), shall be bound to that amount as the cost of providing all or part of the total county mental health program as described in the county performance contract for each fiscal year, to the extent that the governmental funding source participates in funding the county mental health programs. Where the State Department of Health Care Services promulgates regulations for determining reimbursement of Short-Doyle mental health services allowable under the Medi-Cal program, those regulations shall be controlling as to the rates for reimbursement of Short-Doyle mental health services allowable under the Medi-Cal program and rendered to Medi-Cal beneficiaries. Providers under this subdivision shall report to the State Department of Mental Health and local mental health programs any information required by the State Department of Mental Health in accordance with procedures established by the Director of Mental Health.

(c) Notwithstanding any other provision of this division or Division 9 (commencing with Section 10000), absent a finding of fraud, abuse, or failure to achieve contract objectives, no restrictions, other than any contained in the contract, shall be placed upon a provider's expenditure pursuant to this section.

SEC. 7. Section 5708 of the Welfare and Institutions Code is amended to read:

5708 To maintain stability during the transition, counties that contracted with the department during the 1990-91 fiscal year on a negotiated net amount basis may continue to use the same funding mechanism.

SEC. 8. Section 5710 of the Welfare and Institutions Code is amended to read:

5710 (a) Charges for the care and treatment of each patient receiving service from a county mental health program shall not exceed the actual cost thereof as determined or approved by the Director of Mental Health in accordance with standard accounting practices. The director may include the amount of expenditures for capital outlay or the interest thereon, or both, in his or her determination of actual cost. The responsibility of a patient, his or her estate, or his or her responsible relatives to pay the charges and the powers of the director with respect thereto shall be determined in accordance with Article 4 (commencing with Section 7275) of Chapter 3 of Division 7.

(b) The Director of Mental Health may delegate to each county all or part of the responsibility for determining the financial liability of patients to whom services are rendered by a county mental health program and all or part of the responsibility for determining the ability of the responsible parties to pay for services to minor children who are referred by a county for treatment in a state hospital. Liability shall extend to the estates of patients and to responsible relatives, including the spouse of an adult patient and the parents of minor children. The Director of Mental Health may also delegate all or part of the responsibility for collecting the charges for patient fees. Counties may decline this responsibility as it pertains to state hospitals, at their discretion. If this responsibility is delegated by the director, the director shall establish and maintain the policies and procedures for making the determinations and collections. Each county to which the responsibility is delegated shall comply with the policy and procedures.

(c) The director shall prepare and adopt a uniform sliding scale patient fee schedule to be used in all mental health agencies for services rendered to each patient. In preparing the uniform patient fee schedule, the director shall take into account the existing charges for state hospital services and those for community mental health program services. If the director determines that it is not practicable to devise a single uniform patient fee schedule applicable to both state hospital services and services of other mental health agencies, the director may adopt a separate fee schedule for the state hospital services which differs from the uniform patient fee schedule applicable to other mental health agencies.

SEC. 9. Section 5716 of the Welfare and Institutions Code is amended to read:

5716. Counties may contract with providers on a negotiated net amount basis in the same manner as set forth in Section 5705.

SEC. 10. Section 5724 of the Welfare and Institutions Code is amended to read:

5724. (a) The department and the State Department of Health Care Services shall jointly develop a new ratesetting methodology for use in the Short-Doyle Medi-Cal system that maximizes federal funding and utilizes, as much as practicable, federal medicare reimbursement principles. The departments shall work with the counties and the federal Health Care Financing Administration in the development of the methodology required by this section.

(b) Rates developed through the methodology required by this section shall apply only to reimbursement for direct client services.

(c) Administrative costs shall be claimed separately and shall be limited to 15 percent of the total cost of direct client services.

(d) The cost of performing utilization reviews shall be claimed separately and shall not be included in administrative cost.

(e) The rates established for direct client services pursuant to this section shall be based on increments of time for all noninpatient services.

(f) The ratesetting methodology shall not be implemented until it has received any necessary federal approvals.

SEC. 11. Section 5750.1 of the Welfare and Institutions Code is amended to read:

5750.1. Notwithstanding Section 5750, a standard, rule, or policy, not directly the result of a statutory or administrative law change, adopted by the department or county during the term of an existing county performance contract shall not apply to the negotiated net amount terms of that contract under Sections 5705 and 5716, but shall only apply to contracts established after adoption of the standard, rule, or policy.

SEC. 12. No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.