Webinar: Accessing Public Benefits, a National Perspective, with Attorney Stephen Dale

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This webinar took place on Thursday, August 13, 2020

Stephen W. Dale, Esq., LL.M, is a dedicated disability rights advocate and principal attorney of the Dale Law Firm, P.C., based in California. The firm is dedicated to assisting individuals with disabilities with estate and special needs planning. This webinar covers the basics of both needs-based programs (SSI, Medicaid, SNAP) as well as entitlement programs (SSDI, Child Disability Benefits, Medicare). Steve also discusses how wage, unearned income, and resources effect medical benefits and continuing entitlement to Social Security benefits and/or eligibility for the SSI program. COVID related issues and Q&A were included.

Watch the recording on the NCSA YouTube channel here.

New study suggests more than 3% of Japanese children have autism

Increasing incidence mirrors alarming global trends

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By Jill Escher

Okaya is a city located in central Japan with a population of approximately 50,000. 

A new study by Daimei Sasayama et al. of Shinshu University School of Medicine, and published in the Journal of Autism and Developmental Disorders, indicates that after thorough screening 3% of the city’s children have autism.

The researchers evaluated the follow-ups of 1067 (517 boys and 550 girls) six year-olds who had also undergone a screening for ASD at there routine 18-months health checkup. In Japan, a health checkup is performed for all children at 18 months. The study subjects were children born between April 2009 and April 2012.

This study had two main objectives: (1) to present the cumulative incidence of ASD in an area with a thorough screening system, and (2) to examine the behavioral and motor characteristics observed at the age of 18 months in children later diagnosed as ASD.

Retrospectively, the questionnaire answered by caregivers at the 18-month-old checkup suggested that children later diagnosed with ASD showed delay in fine motor and gross motor skills and social and communication skills.

By the age of 6 years, 3.1% (4.3% of boys and 2.0% of girls) were diagnosed as having ASD by their attending pediatricians.

A similar incidence rate was reported in another cohort in Japan (Hamamatsu Birth Cohort for Mothers and Children) last year, where 3.1% of 952 children aged 32 months were found to have autism.

The study is consistent with global trends showing increasing autism rates among children. For example, nearly 2% of U.S. 8-year-old children were reported to have ASD based on CDC data. Northern Ireland reports a rate of 3.2% of schoolchildren. Recent Denmark data showed incidence may exceed 2.8%.

Other findings of the Okayashi study include:

• No significant difference in maternal or paternal age at birth was observed between ASD and non-ASD children. 

• No significant difference between ASD and non-ASD children was present in birthweight or head circumference at birth (controlling for sex) or at the 18-month checkup.

You can find the study (paywalled) here.

50 Shades of Re-homing

Enough with the pearl-clutching: re-homing of one form or another is common, and often necessary, with the severely autistic

By R Medina

A few weeks ago my social media got flooded with posts expressing moral outrage after there was news that a YouTube star and her husband had “re-homed” their severely autistic son, whom they had adopted from China. Apparently the son’s behaviors were more difficult and dangerous than they had bargained for so they found some way to place the boy with another family.

Now I don’t know anything about those YouTubers and this post is not about them or the boy’s autism. Was he a feces-smearer? Was he attacking his siblings? Did he screech at 2am, chew the drywall and break windows? I don’t know what prompted it. But this much I do know. Re-homing, in various direct and indirect forms, is entirely common with severe autism. In fact, one form or another is inevitable in most cases. All the sanctimonious judgment and social media pearl-clutching seemed based in obliviousness about what happens, over time with overwhelmed severe autism families, in the real world.

I would say there are at least 50 different shades of re-homing, from outright giving up custody to many more sublte forms. Clearly few pathways to re-homing are as early or overt as this case. But they all start from the same place, a single parent, couple, or sometimes caregiver sib who are so physically, mentally, emotionally, and/or financially exhausted or imperiled, or who have become so old or infirm, that they can no longer provide adequate care for the child or adult. Very often, as the children grow into adults, they become terrified of their strength and unpredictable violence.

Let me tell you about some of the shades. One is called “ward of the state.” I have a friend who is my age (46). Her younger brother had autism. But when he was young and the parents couldn’t take it any more, they made him a ward of the state. He now lives in a group home in a rural community about 500 miles from here, and his family members visit on rare occasion. When the parents relinquished him was there an uproar? Is there an uproar now? No.

Another shade is called “residential school.” This is a temporary form of re-homing. When an autistic child is too dangerous or destructive for a local school district and parents to handle, the IEP team will sometimes place the child in a residential school, often in another state like Kansas or Utah. Some of these schools are year-round, giving exhausted and overwhelmed parents a long break, with the hope of some improvement in skills and behaviors. When the the clock runs out on the IEP the parents are often faced with the difficult-to-impossible task of finding a new home for the young adult who has just fallen off the services cliff. 

Now let me tell you about the most common form of re-homing, it’s sort of a passive form, a kind of abandonment. It is called “parent (usually the father) has a sort of nervous breakdown and simply leaves.” I have seen this play out more times than I can count. The dad exits, and the child is re-homed to the care of a now single mother, often left impoverished and with little support. Where has the community outrage been when a dad leaves his disabled child — something that happens every day in this country, from what I can tell? Not a peep from the social media arbiters! A mom walks out and BLAMMO HASHTAG WARRIORS GO, but a dad? Here’s your free pass, sir.

Another shade is the group home. I used to work closely with a group home agency. Do you know what? Even people much more mildly disabled than those with severe autism were routinely placed in group homes. People really quite sweet, competent, capable. I never heard a speck of outrage when the families put them in group homes, permanently.

Another shade is inpatient care. When families hit the breaking point, they desperately seek an inpatient program where doctors and therapists could use drugs and therapy to help make the child or adult more manageable. This gives parents a break, sometimes for longer than you would know, I knew of a case like this that lasted almost two years. The single mother had her aggressive, self-injurious autistic son placed in an inpatient program and after that ended he could not return home, so he lives round-the-clock with 2 to 3 caregivers in a home rented through a government subsidy program. I do not pass judgment on her, she did exactly what she needed to do to survive. But it is a form of re-homing. And it deserves no condemnation.

I could go on with other examples, but I hope you see my point. With severe autism, re-homing by other names, other means, happens. All. The. Time.

Finally, can we please acknowledge two things. First, my work with families has shown me the the decision to place a severely disabled child or adult outside of the home is excruciating and heartbreaking for the parents, even for those parents covered in bitemarks and bruises, and who haven’t had a decent night’s sleep in years. It is never done lightly. It is the last resort, done out of desperation. Do not dare to pass judgment on these parents or mob them on social media unless you have walked a mile in their shoes.

One last lap here. Let’s acknowledge the darkest, most horrible truth of all. Parents are temporary. No matter how much they love their disabled kids, they will die. As they age we are in for wave upon wave of massive re-homing of severely autistic adults. Autistic re-homing is not an outlier, but a necessity, these adults have no ability to live on their own. Where they will go, I don’t know, but one thing is clear: whether we like it or not, re-homing is the future of autism.

R Medina is a pseudonym for a mom and disability community worker who lives in Southern California.

Disclaimer: Blogposts on the NCSA blog represent the opinions of the individual authors and not necessarily the views or positions of the NCSA or its board of directors.

New Study Points to Grim Outcomes for Adults with Autism

99% of adults diagnosed with autistic disorder as children are incapable of living independently.

With few exceptions, adults with autistic disorder lacked capacity to work or live independently. (Stock photo)

With few exceptions, adults with autistic disorder lacked capacity to work or live independently. (Stock photo)

By Jill Escher

Forget all the hype about autism as a superpower. A new study out of South Carolina following 187 people diagnosed with autistic disorder found their long-term outcomes to be overwhelmingly negative. A team under Roger Stevenson of the Greenwood Genetic Center published the paper, “Autistic Disorder: A 20 Year Chronicle,” in the Journal of Autism and Developmental Disorders in June.

The subjects were followed over a course of 20 years. They had been enrolled in the study during a three-year period from early 1995 to early 1998, and were between the ages of 1 and 21 at that starting point. All were receiving services for autism from the South Carolina Department of Disabilities and Special Needs. The subjects included 153 males and 34 females, representing a 4.5:1 male–female ratio. Sixty-six percent had white ancestry, 32% black ancestry and 2% other ancestry, numbers that parallel the population in South Carolina. Of the enrollees, 84% had co-occuring intellectual disability. The average IQ in the cohort was 49. Twenty years later, at the average age of 27, the investigators ascertained their outcomes.

The outcome data was grim, showing pervasive inability to live independently, hold a job, or manage money. Few became independent, with 99% unable to live independently. Of those, 70% lived at home with relatives, 21% lived in disability homes in the community, and 8% in residential facilities.

A mere 3.7% attained postsecondary education, about half of those representing certificates from college disability programs. While the majority were considered incapable of holding a job in the competitive workspace, some worked in disability workshops or other sheltered positions. Most participants were incapable of handling money, even with caretaker assistance, with only 9.5% considered capable.

The study also probed questionnaires and biological samples for patterns and causes. It found, for example, that 12% of siblings had autistic, mental health, or other behavioral manifestations, a figure that is in the ballpark of findings from similar studies, if somewhat lower. A review of genetic data revealed that 29 participants (about 15%) had genetic or genomic alterations considered to be pathogenic, but the genetic findings did not correlate with IQ. This rate is slightly higher than the 10% rate commonly seen in other studies, but since this cohort was limited to more severe forms of autism (autistic disorder under the DSM-IV is a segment more narrow than “ASD” under the DSM-5), and therefore possibly more likely to be suffering from genetic disease, this finding is not altogether surprising. In addition, 20 participants were born at or before 32 weeks gestation or had other possible prenatal or perinatal complications. No consistent or diagnostic facial dysmorphology was identified. Structural brain malformations were distinctly rare.

The study findings also underscored enormous unpopularity of the neurodiversity philosophy: fully 95% of parents or caretakers who responded to a study question relating to treatment overwhelmingly desired a cure if one were available.

Overall, the study provided a needed reality check about the long-term outcomes of children diagnosed with autistic disorder. Advocates might hype the idea of autism as a superpower or autistic adults becoming independent and capable of competitive integrated employment, but the data tell another, altogether more devastating story.

Jill Escher is the President of the National Council on Severe Autism.


Autism: It’s time to take the conversation back

“Our families must be heard, our loved ones deserve appropriate resources and services. The intentional blocking/censorship of the severe side of the spectrum must come to a end.”

The author with his family. It’s time for the families that have had the nightmare experiences of severe autism to be leading the conversation about the future of our disabled loved ones, he says.

The author with his family. It’s time for the families that have had the nightmare experiences of severe autism to be leading the conversation about the future of our disabled loved ones, he says.

By Vance Goforth

I’ve been actively advocating for changes regarding issues related to severe autism and severe behavioral disorders for over two years now. This process started after our son Joshua finally received treatment for severe autism and behavioral disorders that had been in crisis levels for years.

I experienced the devastating effects that a broken system had on my son and family and I’ve been screaming from the rooftops ever since. I have seen resistance and outright anger from those who would rather my viewpoint be censored than be addressed. This goes beyond disturbing for me and I find it outright ludicrous that those dealing with severe autism/related diagnoses have been totally dismissed by autism advocates and disability organizations that claim to represent our families.

It was hard enough for us to share our story publicly, but when a prominent disability organization heard about our son and talked to me about solutions, their response was “good luck, several other parents have said the very things you have and haven’t been successful in getting those changes.” Disheartening doesn’t even describe what I felt when I heard those words and also the fact that they weren’t even in the least bit interested in helping by speaking out about what my family had experienced.

I refuse to be talked over and talked down to anymore. It’s time to take the conversation back.

Our families must be heard, our loved ones deserve to be treated with respect and provided with appropriate resources and services. The intentional blocking/censorship of the severe side of the spectrum must come to a end.

I’m very tired of different forms of media asking about our story and saying they will cover the story and then when they find out that it‘s not one of those happy feel-good autism stories, I never hear from them again. This isn’t a shiny-gift autism that gets covered in the news so often, this is a gut-wrenching hard autism that is no cause for celebration for my family or the families that truly understand what I’m talking about. It’s devastating.

Families cannot get resources and services in the form of respite, therapies, in-home care, medication management, behavioral treatments, inpatient treatment (both acute and long term treatment). I know some states are better than others in providing services; but still, there is a widespread lack of needed support for families facing issues related to severe autism and other ID/DD disabilities.

We’re seeing respite resources having their budgets cut, even Medicaid waiver programs are being cut back or delayed like in my state. This is not the right direction, especially when considering that the autism rate continues to rise at an alarming rate.

We are one of thousands of families that can attest to the fact that treatment facilities are overwhelmed and the waitlists are grueling for those in need of immediate help. I’ve sent many emails and testified before state legislators about the need for more treatment centers. Here is the response that truly perplexed me and I’ve heard it more than once. “The state just closed all of the institutions, they will not be willing to explore the idea of adding new treatment facilities.”

What, what????? How is providing treatment facilities being equated with an institution? I don’t know the answer to this but it’s happening. We are already so behind the curve with the increased autism rates, it’s scary and very few are paying attention to the distress calls from families.

I personally know one family that is 3,400 miles from their child because of the shortage of treatment locations. How would you feel if this was your family? The pain and the stress these families face is indescribable. They feel hopeless and totally invisible in a system of advocates and organizations that considers it forbidden to discuss the hard issues of severe autism. Higher functioning advocates champion the closure of anything that is related to or even falsely described as an institution, while refusing to discuss multiple and overwhelming issues created by not providing suitable alternatives when these closures happen.

It’s time for the ones that have had the nightmare experiences of severe autism to be leading the conversations. We need more families to share the systemic inadequacies they face and we definitely need more organizations and legislators to have an open ear to the tsunami of challenges that are hitting families right now and getting worse with time.

Vance Goforth is the father of son with severe autism. He and his family live in Tennessee.

Like the Voice for Joshua Facebook page here: https://www.facebook.com/changeforjosh
Join the Voice for Joshua Facebook support group here

Read more from Vance here:
Walking on Eggshells, a Severe Autism Perspective
The Crisis Call No One Is Willing to Hear


Disclaimer: Blogposts on the NCSA blog represent the opinions of the individual authors and not necessarily the views or positions of the NCSA or its board of directors.

"This is the taboo about autism that no other organization wants to talk about"

Frustrated by tepid mainstream advocacy, an outspoken mom says change will only come if we bust the taboos around severe autism.

The author with her son, D.

The author with her son, D.

By Tonya W

My son D has autism, is 21 years old, and now living in an inappropriate group home. I worry about him every day because he has limited speech and I know that the management and staff have no training working with my son's autism.  
 
He lives in a group home because I can't manage my son when he becomes aggressive, which happens with and without triggers. Meaning he loves Kit Kats. He loves McDonald's 10-piece chicken nuggets with a large fries and Coke. When he says in his own way, ‘Donald's’ or ‘Kit Kit,’ those items better appear quickly or if not here comes the Hulk. This can lead to destruction of property. He can attack staff with trying to bite fingers. 

Then there is the puzzle of him doing the same thing out of nowhere, it just shows up. My son is on meds just for these aggressive behaviors. However, I have witnessed a miracle D getting angry and he understood and captured it and literally took control of it and it went away; he is truly amazing. 

I want to say thank you to NCSA for reaching out and talking about our kids and young adults who can have aggressive behaviors with or without triggers. This is the taboo about autism that no other organization wants to talk about.   

This taboo is why there are no appropriate resources and residential placements, or staff. Or, hospitals that are knowledgeable about autism. 

Our loved ones deserve a caring, very patient, appropriate staff with training from an accredited college for special education, specifically in autism. There should be a special office or department just for autism in all states and counties. There should be facilities built for our loved ones to live, made specifically for autism.  

My son's autism along with your loved ones' autism is a pandemic ignored by organizations like Autism Speaks, The Arc, and Autism Society, to name a few. This recognition is needed in all of the United States. We need appropriate resources to be prepared for the 21 year-olds that have or will be transitioning out of school.  

This also includes the young children and teenagers with autism. Many simply cannot live at home because of the severe autism. Sound the Congress alarms and let's get what is needed our adults, teenagers, and children with autism to have safe, happy, productive long-term care NOW.

Tonya W is the mother of a young man with severe autism. She lives in Maryland.

Disclaimer: Blogposts on the NCSA blog represent the opinions of the individual authors and not necessarily the views or positions of the NCSA or its board of directors.