1. Understanding The Significant Impact of
Poverty on Autism

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. 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. 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. 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. 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. 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. 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. Effects of poverty can contribute to
development of intellectual disabilities &
neurodevelopment disabilities via following
processes (Bergen , 2008):

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. 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. 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. 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. 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. 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. Neurology, Poverty & Autism
 Areas impacted the most by poverty include
(Marston, 2013):
 Hippocampus
 Amygdala
 Prefrontal cortex

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. BHRS Services (continued)
 Coordination between behavioral health and
other services
 Can start at an early age for children with
autism

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. 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. 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. 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. 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. 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. 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. 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. 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