Autism & poverty2

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Autism & poverty2

  1. 1. Understanding The Significant Impact of Poverty on Autism
  2. 2. Daniel C. Marston, PhD, ABPP  Licensed Psychologist  Board Certified in Behavioral Psychology  Owner, Marston Psychological Services, LLC in North Huntingdon, PA  412-380-2695 or 724-433-5467  drdanmarston@comcast.net
  3. 3. Credentials:  Board Certified in Cognitive & Behavioral Psychology, American Board of Professional Psychology  Fellow, American Academy of Cognitive & Behavioral Psychology  Fellow, Pennsylvania Psychological Association  Member, American Psychological Association Division 6 (Behavioral Neuroscience)  Member, American Association of Intellectual & Developmental Disabilities (AAIDD)  Division Representative, APA’s Committee on Socioeconomic Status
  4. 4. Purpose Of This Presentation  To provide an overview of the impact that financial poverty has on individuals with autism diagnoses and their families  Also, to provide some suggestions about what can be done to help address this significant problem
  5. 5. Poverty is a widespread problem  According to the U.S. Census Bureau, 46.2 million now live below the official poverty line set by the U.S. government (Tavernise, 2011)  Poverty significantly effects how people live their lives and what resources are available to them for addressing problems  As we will see during this presentation poverty also significant effects physiological development and what services people seek out  This presentation will address specifically what impact poverty has on individuals who have autistic spectrum disorders
  6. 6. Mandell, Novak & Zubritsky (2005)  Found no statistically significant differences between poor & wealthy families in terms of the frequency with which children were diagnosed with autism  They did find differences in terms of when autism is diagnosed  Children with autism from poorer families tended to be diagnosed an average of 11 months later than children from wealthier families  Differences in terms of insurance coverage was identified by the authors as one likely reason why this was the case  Authors also cited limited access to specialists in the diagnosis & treatment of autism in poorer communities as another reason  Less access might impact on the frequency with which autistic children are accurately diagnosed & effectively treated in poorer communities
  7. 7. Chronic stress associated with poverty  Can significantly impact on development of prefrontal cortex  Evans & Schamberg (2009)  Wilber et al (2011)  Impact of poverty on development of autism can likely be seen primarily in the effect on the prefrontal cortex region of the brain  This would not necessarily effect whether autism develops but would significantly impact on how it develops  Could likely impact on the severity of symptoms associated with autistic spectrum disorders
  8. 8. Poverty & Child Development  Studies have shown negative association between poverty & child development.  Summarized in Hetzner, Johnson & Brook-Gunn (2010)  Children from poor families are more likely to experience developmental delays than middle class peers  Poverty not necessarily a cause of autism but can make the developmental problems in autistic disorders worse
  9. 9. Effects of poverty can contribute to development of intellectual disabilities & neurodevelopment disabilities via following processes (Bergen , 2008):
  10. 10.  Protein-energy malnutrition  Dietary micronutrient deficiencies  Environmental toxins  Lack of early sensory stimulation or the ability to profit from it  Authors propose that reduction in poverty would reduce the frequency of intellectual disabilities in this country & other countries
  11. 11. Causes of Autism & Poverty  Causes of autism remain unclear  There is little definitive evidence of what factors might cause autism  Much of the research on any factors have been mixed  One study supports one factor and another study supports something different
  12. 12. Causes of Autism & Poverty (continued)  Kolevzan, Gross & Reichenbery (2007) provide a review of this issue  Some factors thought to play a role include:  Low birth weight  Low Apgar score  Fetal distress  Environmental toxins
  13. 13. Causes of Autism & Poverty (continued)  Research on impact of these factors have been mixed  But each of these factors could be significantly impacted by poor nutrition, lack of resources and poor environments  Those are each most likely to be problems for families in poverty  So, whatever role these factors play is likely to be impacted by poverty
  14. 14. Poverty & Autistic Services  In study of autism diagnoses in California, King & Bearman (2012) found that lack of services had most impact  Lack of access to diagnostic and treatment services impacted on whether autism diagnoses were made in the first place  This would impact on whether diagnoses made at all  Also would impact on whether and when services were obtained
  15. 15. Poverty & Autistic Services (continued)  Particularly important for autism given evidence that services obtained early on have the most beneficial impact on functioning in autism (Kogan et al, 2009)  Again, evidence shows that poverty does not necessarily impact on whether autism develops but does likely impact on how autism develops
  16. 16. Neurology, Poverty & Autism  Areas impacted the most by poverty include (Marston, 2013):  Hippocampus  Amygdala  Prefrontal cortex
  17. 17. Neurology, Poverty & Autism (continued)  Each of these are areas that also likely play a significant role in autism  Review in M. Coleman’s book “The Neurology of Autism”
  18. 18. Neurology, Poverty & Autism (continued) Prefrontal cortex has been extensively implicated in autism to explain deficits in executive functioning, cognition, language, sociability & emotion  Rinaldi, Peroddin & Markram (2008)  Price (2006)
  19. 19. Neurology, Poverty & Autism (continued) • Cognitive areas most impacted by poverty:  Executive Functioning  Working Memory  Social Comprehension  Emotion Regulation • These are also cognitive areas that play a significant role in autism
  20. 20. Poverty & Autism—The Numbers  In 2010, article published by Maureen Durkin et al led to misleading conclusions about autism & socioeconomic status (SES)  Entitled “Socioeconomic Inequality in the Prevalence of Autism Spectrum Disorder: Evidence from a U.S. Cross-Sectional Study” (PLoS ONE, 5(7): e11551)
  21. 21. Durkin et al (2010) Study  Compared to medium income homes, authors found autistic disorders to occur 70% of the time in low SES homes but 125% of time in high SES homes  This led to articles in print and online publications with silly titles like “Does Poverty Cure Autism?” (Huffington Post Sept. 22, 2010 edition)
  22. 22. Durkin et al (2010) article (continued)  Further review of research shows that the diagnostic differences due to less access in SES homes to needed services  Particular problem is lack of specialized services for addressing autism
  23. 23. Autism & Employment  In UK, estimate is that only one in six adults with autism are employed (The Independent 10/12/2009 edition)  UK’s National Autistic Society accused their government of condemning people with autism to life of poverty  Main issue identified was lack of resources to help people with autism find jobs
  24. 24. Autism & Employment (continued)  In a study of U.S. teenagers and young adults, individuals with autism had lowest rates of employment & highest rates of unemployment than individuals in other disability categories  Shattuck et al (2012)  Less than 50% were employed  Higher income & higher functional ability were found to be associated with higher rates of employment
  25. 25. Autism & Employment (continued)  Individuals with autism from lower-income families were at greater risk for poorer outcomes  Notice circular outcome here, individuals with autism from poor families were less likely to be employed and, therefore, more likely to remain poor
  26. 26. Autism & Employment (continued)  In another study of US young adults, those with autism found to have third highest rate of employment among groups who received specialized vocational services  Cimera & Cowan, 2009  Employment rate for autism was 40.8%  However, this still meant that almost 60% were unemployed
  27. 27. Autism & Employment (continued)  Also, this study found that individuals with autism worked fewer hours and earned lower wages than nearly all of the other 9 groups studied  As a group, individuals with autism earned an average of $146.65 per week  In comparison, individuals with physical impairments earned $277.02 and medical impairments earned $249.04 per week
  28. 28. Autism & Employment (continued)  At an annual rate of $7,625.80 this would be well below poverty line for individual  Dept. of Health & Human Services website ( www.hhs.gov) lists 2013 poverty line for individual as $11,490 per year
  29. 29. Cost of Services—Impact on Poverty  Another significant problem found in Cimera & Cowan study was cost of services for autism  Cost of services for individuals with autism were more expensive than all but one group in the study  Financial impact of obtaining services is another contributing factor to autism & poverty
  30. 30. AUTISM & ECONOMIC STATUS  Sharpe & Baker (2007)  Poverty can have an impact on development of individuals with autism  Autistic syndromes can also be a cause of financial difficulties for families  Unreimbursed medical or therapy expenses can significantly impact on financial status of families  Montes & Halterman (2008) studied a nationally representative sample of families & found that families who have children with autism earn 14% less than demographically & educationally comparable households
  31. 31. Montes & Halterman (2008)  Found that autism can effect income level of family to a significant degree  Surveyed 82 parents of children diagnosed with autism, 1,955 parents whose children were considered to be a high risk for developmental problems & 14,409 typically developing children  39% of parents with autistic children reported that problems with child care had greatly effected their employment decisions.
  32. 32. Montes & Halterman (continued)  This was significantly larger than the 16% for parents of high risk children & 9% for parents of typically developing children  In multivariate analyses families with autistic children were 7 times more likely to say that child care problems effected employment decisions, after controlling for household & child covariates
  33. 33. Myths about people in poverty (Gorski, 2008):  Poor people are unmotivated and have weak work ethics  Poor people are unmotivated to help their children  Poor people share monolithic and predictable beliefs and values  Poverty results not from gross inequities but from poor people’s own deficiences
  34. 34. ADDRESSING EFFECTS OF POVERTY ON DEVELOPMENT  Hetzner, Johnson & Brook-Gunn (2010) offered policy implications that can help address effect of poverty on child development  Programs like Head Start that help increase more positive parent-child interactions  Home visits can help enhance home environment  Programs offering comprehensive sets of services  Focus interventions to address early childhood development whenever possible
  35. 35. Putting this into effect for helping individuals with autism  Focus on interventions for children that help to increase more positive parent-child interactions  Provide interactions for families for helping members recognize interventions to best address autistic symptoms  Provide comprehensive services within one setting  This can involve practitioner providing advocacy, information, assessment and interventions as part of therapeutic services provided to families and individuals  Focus on providing interventions early for addressing childhood development
  36. 36. BHRS Services  Can help address those recommendations  Provided under Medical Assistance insurers  Available to low income families  Services provided in the home  Starts with comprehensive psychological evaluation  Focus on interventions parents and families can use
  37. 37. BHRS Services (continued)  Coordination between behavioral health and other services  Can start at an early age for children with autism
  38. 38. Other Recommendations  Prenatal care important  Can be obtained through Medical Assistance and community programs  Families may need assistance in finding needed services  May also need help in understanding how insurance programs work  Example-Many families may not realize they can contact insurance company directly  May think they need physician referral for services
  39. 39. Other Recommendations (continued)  Good nutrition is important  Obtaining help in maintaining good nutrition may be difficult to find  Minimizing environmental toxins is important  Identifying environmental toxins may take some work and effort
  40. 40. Other Recommendations (continued)  Support Services through schools need to be Individualized  Work to make sure that IEPs do not just follow a general template  Make sure support services and recommendations are individualized to the child’s needs  Utilize vocational training programs in schools
  41. 41. Strategies for Helping Individuals with Autism Obtain Employment  Hendricks (2010)  Specialized job training & placement services  Traditional vocational rehab services not very effective for individuals with autism  Voc Rehab services often do not meet specialized needs of autism  Individualized job placement services most effective
  42. 42. Obtaining Employment (continued)  Job placement considerations must include focus on jobs appropriate for individuals  Social skills and abilities must be taken into consideration  Supportive work environments are important  Supervisors and other employees who provide flexibility & tolerance
  43. 43. Obtaining Employment (continued)  Training programs that target job tasks, acclimation to the job and social integration  Extensive and long-terms support from job coaches
  44. 44. Policy Implications  Importance of prenatal services  Focus on how autism develops and not whether it develops  Addressing poverty can impact on severity of autism later on  Poverty can have real implications for need for disability services for teenagers and young adults
  45. 45. Policy Implications (continued)  Need for support services throughout the lifespan and not just childhood  Importance of help in finding and obtaining services  Obtaining support services is important for breaking cycle of poverty  Individualized and specialized job training and job placement services are essential
  46. 46. Conclusion  Helping individuals and families facing autism & poverty find and keep specialized services early on is important  Maximizing functioning and maintaining employment when possible is important for minimizing the impact of financial poverty

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