“To Infinity and Beyond” Let’s Discuss Gestalt Language Processors By Speech Language Trainee, Megal Magdaleno

It wasn’t until recently, as I began to work more deeply with Autistic children, that I learned what Gestalt Language Processors (GLPs) were. I remember identifying this type of language processing (way of learning language) as Echolalia, which is the repetition of language in whole chunks. However, I was taught to ignore and decrease this type of language as it disrupted structured spaces, like a classroom, and was considered “unnatural”. I am happy to say that after much research and clinical experience, I now understand the shifts our healthcare professionals are taking to better support GLPs. In this blog post, I will discuss further who and what considers someone a GLP, what healthcare professionals can do to best support them, and share additional resources to learn more.

So what is GLP? Well according to Marge Blanc and The Communication Development Center, GLP is just one way a child can develop their language. Most children learn language through Analytic Language Processing (ALP), which means that children are learning language through single units or individual words that gradually move to sentences. However, many neurodiverse individuals are GLPs, which means they develop language through memorized chunks or phrases and then move to single words. I remember a colleague of mine once described the two as so: ALPs learn language brick by brick (word by word) to eventually build their house (using phrases/sentences); whereas GLPs already have their houses built. 

Now that we have a basic understanding of the differences between GLPs and ALPs, let’s talk about what we can do to best support them. When working with GLPs we must use our detective hats to figure out what the gestalt used really means. Remember, we shouldn’t take an individual's gestalts literally because they can serve many communicative functions. For example, if a child says “To infinity and beyond”, it is our job to understand what they really mean. A child can use that phrase to mean “Let’s go” or “Let’s watch Toy Story” etc. In the process of us being detectives, we must also remember to always acknowledge whatever language the individual is producing, even if we do not understand it. This can be seen through head nodding and verbal feedback “I hear you”. All language is beautiful language and it’s our job to honor and validate whatever type the individual is using. Lastly, when interacting with GLPs we must make an effort to decrease the number of questions we present and instead use declarative statements. This switch promotes the use of spontaneous language and allows the individual to receive further examples of the language they can use themselves. For example, instead of asking “do you like apples or bananas” we can say “I love apples” or “wow look at those green apples, so yummy!”. 

Although there is so much more information I did not include in this post, I hope this at least sparked a new interest for you to consider working with neurodiverse populations. To further your understanding, I have provided some resources below: 

  1. How can I explain GLP to parents?

  2. Where can I learn more about GLPs?

  3. Are there any social media accounts that I can follow? 

    1. https://www.instagram.com/meaningfulspeech/

    2. https://www.instagram.com/bohospeechie/ 

    3. https://podcasts.apple.com/us/podcast/two-sides-of-the-spectrum/id1514489746?i=1000549763022 












 



Navigating Challenges: Korean Immigrant Parents of Children with Autism in the U.S. by Special Ed Trainee, Namhee Kim

The Korean American community, including immigrants, has experienced remarkable growth in recent years, becoming one of the fastest growing and largest immigrant populations in the United States (Pew Research Center, 2019). Along with this growth, there has been a notable increase in the number of Korean immigrant parents raising children with autism in the country (Center for Disease Control and Prevention, 2018).

Figure. Korean Immigrant Population in the United States, 1980-2019 Migration Policy Institute. https://www.migrationpolicy.org/article/korean-immigrants-united-states)

Data from U.S. Census Bureau 2010 and 2019 American Community Survey (ACS), and Campbell J. Gibson and Kay Jung, “Historical Census Statistics on the Foreign-born Population of the United States”. 1850-2000”

 

While the U.S. offers opportunities and resources for families with children on the autism spectrum, the cultural adaptation process and language barriers can present significant challenges for these parents. In this blog, I will explore the challenges faced by Korean immigrant parents, focusing on the language barrier and its impact on accessing services for their children with autism. Additionally, I will delve into the essential role played by the Korean community church in providing support and fostering emotional well-being for these parents.

 

1. Language Barriers: A Major Stressor

As a counselor working with nonprofit organizations in Chicago, I have had the privilege of witnessing firsthand the struggles of Korean immigrant parents in navigating the complex systems of autism services in the U.S. Language barriers frequently arise as a major stressor, hindering effective communication between parents and service providers. Understanding the terminology used in special education, such as Individual Education Plans (IEPs), can be particularly challenging for parents with limited English proficiency. Consequently, some parents opt to confide their concerns in other Korean parents of children with disabilities within their community, seeking solace and understanding in shared experiences. While the sense of community support is valuable, avoiding direct communication with English-speaking service providers may impede the effective addressing of their children's behavioral and academic challenges.

 

2. The Quest for Bilingual Support

While conducting interviews with Korean immigrant parents of children with autism, a recurring theme emerged: the yearning for access to Korean bilingual professionals who could offer specialized support. Parents residing in remote areas expressed a desire to relocate to metropolitan cities like Los Angeles, New York, or Chicago, where the availability of Korean-speaking Board-Certified Behavior Analysts (BCBAs) and other professionals would be more prevalent. Having service providers who not only understand their language but also their cultural nuances can significantly impact their children's educational experiences and overall support network. It is a testament to the importance of cultural competence and inclusive practices in the field of autism services.

 

3. The Church as a Support System

Amidst the challenges posed by cultural adaptation and language barriers, Korean community churches have emerged as indispensable support systems for parents and families. These churches serve as vital hubs where Korean immigrant parents can connect with one another, forming a close-knit community that shares their experiences, challenges, and triumphs concerning their children's education and services (Kim& Kim, 2017). The benefits of these connections extend beyond religious activities, as the churches often host gatherings on national holidays (e.g., New Year, Christmas), events like birthdays, and prayer groups. In these supportive environments, parents find emotional comfort and camaraderie, knowing they are not alone in their journey. The sense of belonging and the assurance of a shared cultural background (Kim et al., 2010) create a safe space for expressing concerns and seeking advice from fellow parents.

 

4. A Call for Research and Support

Despite the growing number of Korean immigrant communities and parents raising children with disabilities, there remains a notable lack of research that specifically investigates the stressors arising from cultural and linguistic barriers. As we recognize the unique challenges faced by these parents, it is crucial to invest in research efforts that delve deeper into their experiences. Understanding the specific needs of Korean parents with language barriers can inform the development of culturally competent interventions, thereby facilitating access to services and support for their children with autism. Additionally, we must continue to nurture the support systems that have proven to be instrumental in easing their journey, such as the Korean community church and other community-based initiatives.

 

Korean immigrant parents raising children with autism in the U.S. encounter distinctive challenges stemming from cultural adaptation and language barriers. The language barrier poses significant stress, affecting their ability to effectively communicate with service providers and access appropriate resources.

References

1.           Centers for Disease Control and Prevention. (2018). Prevalence of autism spectrum disorder among children aged 8 years : Autism and developmental disabilities monitoring network, 11 sites, United States, 2014. Mortality Morbidity and Weekly Report Surveillance Summaries, 67(6),1–23.

2.           Kim, J., & Kim, S. (2017). Positioning of Korean immigrant mothers of children with disabilities. International Journal of Multicultural Education, 19, 41–64. https://doi.org/10.18251/ijme.v19i3.1362

3.           3. Migration Policy Institute. (2019). Korean immigrants in the United States. https://www.migrationpolicy.org/article/korean-immigrants-united-states-2017

4.           4. Pew Research Center. (2019). Key facts about Asian origin groups in the U.S. https://www.pewresearch.org/fact-tank/2019/05/22/ key-facts-about-asian-origin-groups-in-the-u-s/

 

Expectation: A strong belief that something will happen or be the case in the future by Megan Best, Special Education Trainee

Expectations. School expectations. Job expectations. Clear expectations. Unwritten expectations. Expectations of others. Expectations of self. Whatever our place in life, there are always expectations. As a special education teacher, there were countless expectations. Expectations for me as a teacher by the school, families, and state. Expectations of myself for doing what was best for my students, their families, and my colleagues. I also held expectations for my students. A lesson I learned quickly is the higher you set your expectations, the more likely students meet those expectations. I expected my students to achieve success, find value and confidence in themselves, while also expecting myself and my team to individually support students to help them reach their goals. I would say that as a special education teacher, I held high expectations for students.

As a special education teacher in multiple settings, as well as a special education administrator, I found that not everyone is quick to discuss “high expectations” when supporting individuals with intellectual and developmental disabilities. Often, future planning options were discredited because goals were deemed “impossible” or “infeasible”. But, can adults with intellectual and developmental disabilities be gainfully employed? Yes. Can adults with intellectual and developmental disabilities pursue higher education? Yes. Can adults with intellectual and developmental disabilities live independently in their communities? Yes. The answer is always yes, but the solution may require creative planning and interagency collaboration.

When I reflect on the field of special education, I think there is so much more to achieve. I don’t hold all the answers or solutions (some days I wonder if I hold any), but I do have high expectations that as a field we need to honor families, work collaboratively, and be responsive to students' preferences, strengths, goals and dreams. We need to allow students the opportunity to take learning risks, facilitate opportunities to develop meaningful relationships, and dream big, incredible dreams for adulthood. We need to advocate for inclusive practices, which in turn, may yield a more inclusive society. It sounds like a lot- because it can be a lot.

What kind of a teacher would I be if I didn’t share a tool to support others in this journey? 😉 A tool that I would love to share is a conceptual framework titled, “Universal Design for Transition.” It is an incredible tool to support the work of holding high expectations for students with disabilities to be exposed and engaged with grade-level standards, functional skills, and achieving their transition goals. Building off of Universal Design for Learning (UDL), which emphasizes multiple means of expression, engagement, and representation, it also includes multiple means of assessment, multiple means of life domains, multiple resources/perspectives, and individual self-determination. A book that I would recommend to any (and every) secondary teacher supporting students with intellectual and developmental disabilities is titled, Universal Design for Transition: A Roadmap for Planning and Instruction. It provides tangible examples and excellent tools to support “doing it all” to help our students and their families achieve post-secondary goals and success. It supports raising the bar and setting those expectations high. I wish I had had it earlier in my career!

Expectations. We all have them, for others and ourselves. May our expectations be raised so that we can continue to work toward an inclusive society that values each individual, disabled or non-disabled.

Disability Accommodations in Higher Education: “It’s not one size fits all.” By Cassandra W., LEND disability studies trainee

The following interview is a partial transcript between LEND trainee Cassandra and Em (she/they), an autistic person navigating the complicated nature of higher education. Cassandra and Em connected through the 2021 doctoral student cohort.

 

*To protect privacy some names have been changed

[Image: Black chalkboard with yellow, pink, and blue scribbles]

CW: Thank you for joining me today as part of a classroom requirement for a lender, I will be interviewing you just asking you some basic questions about yourself and your experiences as an autistic person in higher ed. So, do you mind telling us a little bit about yourself, in general?

 

Em: So yeah, I, as you said, like, I'm autistic person, I started this graduate program at the start of last school year. So, this is my second year finishing the third semester.

 

CW: Great. Can you tell us like some of your interests, like research areas of interest?

 

Em: Yeah, so as an autistic person, I am interested in research pertaining to autistic folks, but I, want to do research that I feel like is more beneficial to actual autistic people. And a lot of my research interests overlaps with, like my own identity and experience. I'm working on a master's thesis right now, that looks into how queer and trans autistic folks create their sexual gender and autistic identities.

 

CW:  Yeah, that's interesting. What sparked your interest in that? Is there a research gap for queer and autistic folks?

 

Em: I have all those identities, I identify as queer and gender queer. When I look into experiences of like, actual autistic people, like online talking about their identities, it makes a lot of sense, but then whenever I look up these topics, more on the academic side of things, it is very medicalized, it tends to be very medicalized. Like trying to figure out why they like there's this trend but ends up kind of more pathologizing instead of celebrating identity development. For instance, kind of almost treating the medicalized idea of gender dysphoria as a co-occurrence with being autistic. Which I feel like can kind of be problematic, like, that's not saying like, autistic people don't experience gender dysphoria, but is the way it is medicalized. But that assumes that only like occurs in this certain way which I find problematic.

 

CW: I'm curious, as an autistic person, what's your experience been like? Whether good or bad, and maybe you could provide a few examples?

 

Em: Yeah, I would say overall, it's been good. I wasn't formally diagnosed until high school. And I wasn't really given accommodations until then, either. But accommodations were kind of limited to things like standardized testing. It wasn't really considered like, oh I also get extended time when it comes to just the end of the unit tests that teachers make and assign or with assignments. And so that was often a struggle, and I had to advocate for myself because I did not have good case managers.

And when I got to college, I actually did dual enrollment. This occurred with dual enrollment as well, but it was a given that extended time means that you go to a separate testing location, regardless of whether it is a brief quiz or a test or whatever, so that you have more time, they have the quiet environment. But I still had instances where I struggled some. When I first went to college, I went to a very small liberal arts college and they had a great Disability Resource Center. And in retrospect, I think that was because the school so was so small, if I was ever having any issues with anything, I could just walk in and talk to one of the two directors who worked there, and they were the only employees, they just always had open office hours like that, and would come up with very creative solutions. In fact, I've come back to those ideas since I came into grad school like using PDF to text readers to like to listen to readings to save some time, instead of trying to just sit down and read everything.

 

Em: So, when it got to the following fall semester, where I was having a lot of my executive functioning just completely slow down due to the pandemic circumstances. And a lot of people don't understand that executive functioning really, in its most basic terms, just means that like, your brain functions differently and sometimes slower. A lot of people equated with time management issues, which is not necessarily the case. For all autistic people, you can have issues with time management and not have issues with executive functioning and vice versa. So I was having to basically advocate for myself that I had extended time accommodations, and to get more time to complete a final and I ended up getting like a lot the patronizing language of ‘oh, you should be lucky that you got this because the real world isn't this way,’ when in fact, the real word is, because I am allowed accommodations. And I felt like the, that spring semester, spring 2020, when the pandemic first started, I also had to get incomplete in a class and I had all these issues, and the DRC wasn't really there to help me.

 

CW: It sounds like you have had to do a lot of self-advocacy. If you had to give recommendations to other autistic folks who are in higher ed, is there something that you would really want them to know about self-advocating?

 

Em: That's a good question. Because I think the unfortunate reality is self-advocacy to an extent like is self-taught. It is a survival skill. I think what I will say is that, this doesn't quite answer your question, but if this was to be advice in terms of like, how to survive college, I would say it is very helpful to try to meet with Disability Resource Centers to figure out how they handle accommodations. I remember when I was touring undergrad schools, there was this one private women's college I considered going to, but since it was private, they're like, ‘oh if you have accommodation needs, you just talk to like the dean of your school, and they'll handle it for you.’ That is such a big red flag for me. There wasn't actually a department? So, just try to go to a school that has good Disability Resource Center, and then go ahead and try to make sure you can get all the accommodations that you can, so if you run into a situation where you need to use them, you can say, ‘Hey, I have this.’

 

CW: What is your experience in our department been like? Has it been what you've hoped for considering that they have large disability presence?

 

Em: I have accommodations, but it's been hard to figure out I guess, it’s not as straightforward as how to implement those as it is with the way undergrad is set up. And so, it's it has really come down to more the pedagogy that like instructors have. So, for example, the way Dr. Smith and Dr. Miller’s classes were set up were very beneficial. And I found very helpful, because you had that two- or three-day grace period and those in instructors in general, were very understanding if you needed more time, but they also [were] trying to break away as much from the academic institution as possible. So, those classes I felt very comfortable in and they're very big on expressing your access needs and stuff like that.

And then there was course A, which was a mess. We knew we had a final, but we weren't actually told what that final was until the last five minutes of the last class. And that just ended up being a mess for me as it was for everyone. I'm recalling the group chat of where there were people who like pulled 48 hours to get everything done on time.

 

CW: Yeah, I remember that.

 

Em: I never stayed up past midnight to complete assignments until that semester. I remember I was like, up until like 1:30 AM. And it was Saturday morning, and I ended up emailing Dr. Smith, I was like ‘Hey, I'm not done with your assignment, because it was now the end of the two day grace period. I'll get this done like later today.’ And Dr. Smith emailed me back, ‘That's what your accommodations are for, when you run into situations like this.’ That was the first time I had someone really acknowledged what those accommodations were really for. So many instructors are like, ‘Oh, you can get extended time, but you need to let me know like way in advance if you need the extended time.’ Not realizing that sometimes you don't know how long things will take you some time, and all these other factors that just come from having a disability.

 

CW: So, if I hear what you're saying is: if you could change university systems for autistic folks, you’d recommend more flexibility in deadlines, greater attention to the accommodations and more awareness of that people have different disabilities?

 

Em: Yeah, there is definitely power with more awareness of different disabilities. Because one thing I personally noticed, there seems to be a greater understanding of disability. But for instance, people might have more understanding of physical disabilities, and they don't quite understand what it's like, for invisible disabilities. That's just an observation I'm making. It's not in terms of favoring one disability over the other, it's actually like they're more specialized in one area, that they don't quite realize that it's not a one size fits all.

              I would also add that while it is important to have self-advocacy skills, I would personally benefit from having someone to advocate for me on behalf. When I finally shared with my advisor what had happened to me at the end of last Fall semester she was like ‘if anything ends up happening to you like that again please let me know and I will help you advocate for you.” And like, I never had anyone tell me that before, because sometimes it is a lot to be able to self-advocate for yourself, and people don’t listen. It is stressful and to be able to have an ally who is perceived as being “higher up” to be able to do that for you when you need it, it is really helpful. I think we need more allies to help advocate for disabled students when self-advocacy is not enough. 

 

Special thanks to Em for her time and sharing her perspective.

Cuidando a Mama, Caring for Mom By: Physical Therapy Trainee, Ale Hernandez

How to be a good mother by Jake Ghar (2022); pictured is a mother holding her son tight both with eyes closed and smiling faces.

My Abuela, grandmother, always used to tell me “Take care of your mom, you only have one.” Of course, I understood how important my mom was to me; however, it didn’t really sink in until I saw the pain my mom went through after losing her mom. In many cultures, mothers take on the caregiver role for all their children and family members. They are dependable, caring, loving, and selfless. Mothers all around the world, give as much as they can to make sure their children are well taken care of. These demands often surpass one’s ability to do alone and are far more demanding for a mother caring for a child with a lifelong disability.

A qualitative study was done on Latina mothers caring for a child with and without an intellectual and developmental disability (IDD). What they found is that many Latina mothers from both groups are more than likely to be immigrants from low socio-economic backgrounds and have language barriers, but have a rich social support compared to non-Latina caregivers.2 These characteristics place Latina mothers in a position where they must work three times as hard to receive and provide support for their child. Many of these mothers are full-time caregivers for the rest of their child’s life into adulthood.

Services slowly start to decline after 18 years old and become more difficult to receive for children with IDD, but they are still available, nonetheless. However, the maternal care really falls off after a child turns 3 years old and ages out of early intervention where there has been increased support in providing maternal care for mothers that are more vulnerable to mental health struggles. The qualitative study determined that Latina mothers caring for a child with IDD are more than likely to be obese and experience depression, arthritis, hypertension, and overall, more poor health outcomes when compared to other Latina mothers of the same age.2 In addition, they reported that they are less likely to see a doctor or take advantage of respite care as it may distract them from caring for their child and feeling a sense of guilt.

It is important that as interdisciplinary healthcare professionals, we are also providing resources and supports to mothers, as they are most often the primary caregiver and can only provide lifelong support if they, themselves are healthy. By caring for the health of mothers, it will also reduce healthcare costs for both the mother and child and allow the child to continue to have their biggest advocate as they transition into adulthood.

As a student physical therapist, I have learned a lot about how important the biopsychosocial model is because it is a framework that integrates different aspects that influence a patient’s wellbeing. As individuals we are multi-dimensional and the communication between the primary and secondary patients’ teams are important. The teams do not only include their doctors, but also their family. We are only able to spend anywhere from 2-3hrs/week with patients, which is not enough to provide change in their lives; thus, the goal is to understand the patient/family needs and equip them best to implement change on their own. One of the beauties of working in physical therapy is that we often see the patient more than they see their primary doctor and maybe even some of their family members. We can build connections and understand the struggles they may be facing.

Being a LEND trainee has taught me to take advantage of these relationships and be an advocate for not only our patients but also their families. LEND has provided me with a ton of resources regarding disability that I would have otherwise never heard of. It has also allowed me to understand some of the family struggles, and I hope that I can provide resources and be a person that mothers can trust because we only have one.

 

Reference

1.     Ghar Jake. How to Be a Good Mother .; 2022. https://ideas.hallmark.com/articles/encouragement-ideas/how-to-be-a-good-mother/ . Accessed 2022.

2.     Magaña S, Li H, Miranda E, Paradiso de Sayu R. Improving health behaviours of Latina mothers of youths and adults with intellectual and developmental disabilities. Journal of intellectual disability research. 2015;59(5):397-410. doi:10.1111/jir.12139

 

Impacts of Sociocultural and Systemic Factors on Diagnosis and Treatment of ASD: What Physicians Need to Know by Public Health Trainee, Lisset G. Perez Carapia

My nephew was diagnosed with Autism Spectrum Disorder (ASD) when he was four. Once I began my graduate program, I began to have access to information regarding neurodevelopmental disorders and disabilities. Throughout my courses, I learned that the diagnostic rates for Latino children are lower and that Latino children are more likely to receive a late diagnosis when compared to white children (Coffield et al., 2021).

I am currently in a graduate public health program with a concentration in Maternal and Child Health. A significant focus in my academic career has been immigrant health and health literacy in the Latino community. As I first began trying to educate myself more on this topic, I realized that disabilities are not openly discussed in the Latino community I grew up in. Before I entered my graduate program at 23, I didn't know the definition of ASD. After learning about ASD, I decided to immerse myself in literature, and this is what I found.

            Hispanic/Latino Americans are the second largest ethnic group in the United States. In 2020, the Hispanic/Latino population reached 62.1 million, accounting for 19% of the country's population (Funk & Lopez, 2022). This number will only continue to rise as the years go by.

Research suggests that this neurodevelopmental disorder can be equally found across all ethnic groups, but there are consistent inequities in the diagnosis and treatment of non-White groups (Rivera-Figueroa, 2022). It is also important to note that both non-white and white parents experience similar barriers when accessing services for their children with ASD. However, the reasons vastly differ between groups (Rivera-Figueroa, 2022). Sociocultural factors influence how and when immigrant families seek diagnosis, but what does this mean?

Physicians and care providers must become familiar with the perceptions surrounding ASD among immigrant Latino parents and caregivers. Both qualitative and quantitative research suggests that many Latino parents attribute ASD symptoms to bad parenting or poor family dynamics. Unfortunately, research also suggests that Latino communities still perceive disabilities as a shameful experience that must not be spoken about (Rivera-Figueroa, 2022). Another significant barrier in the Latino community is gender roles. As we can see, culture plays a large part in perceptions. A study by Zuckerman (2014) revealed that mothers felt like the fathers saw having an autistic child as weak and as a poor reflection of them as a man. This often leads to the mother being the primary caregiver of the child which consequently leads to fathers being uncooperative in the diagnostic process and passive with care (Zuckerman et al., 2014).

Systemic factors play a significant role in diagnosis and treatment. Physicians and care providers must be aware of the lack of representation in ASD research that Latino children and their families encounter (Rivera-Figueroa, 2022). This highly limits the understanding of the specific needs of this community. Awareness of the language barriers many Latino families face is also essential. In their article, Rivera-Figueroa et al. (2022) explain that parents of children with ASD who were only Spanish-speaking received low-quality information and education about ASD symptoms, treatment plans, and resources. Ethnographic studies have shown that families have hesitated to advocate for their children due to fear of retaliation and being shamed or stigmatized. It was also found that those parents who did decide to advocate were ultimately questioned, underestimated, and ultimately denied access to services by school professionals (Rivera-Figueroa, 2022).

Overall, these factors contribute to the delay in evaluation and diagnosis. Consequently, this means Latino children with ASD receive early intervention at lower rates when compared to their white peers. In addition, a diagnosis of Autism can be a scary and challenging time for many families. Therefore, it is vital that families and their children feel supported and safe when walking into any clinical space.

Lastly, physicians should play into this communities' most significant protective factor, familialismo. This is a term that describes the family-centered values across the Latino community. Many live in multigenerational homes and have extended family members who make up a tightly-knit support system. As a result, family-centered values have been linked to a better quality of life (Rivera-Figueroa, 2022).

 

My goal with this piece was to raise awareness on this subject. I hope each of you who took the time to read this learned something new.

 

References:

 

Coffield, C., Deborah, S., Harris, J., & Jimenez, M. (2021, December). Exploring the Experiences of Families of Latino Children Newly Diagnosed With Autism Spectrum Disorder. Journal of Developmental & Behavioral Pediatrics. Retrieved January 27, 2023, from https://doi.org/10.1097/DBP.0000000000000965

Funk, C., & Lopez, M. H. (2022, June 16). 1. A brief statistical portrait of U.S. hispanics. Pew Research Center Science & Society. Retrieved November 11, 2022, from https://www.pewresearch.org/science/2022/06/14/a-brief-statistical-portrait-of-u-s-hispanics/

Rivera-Figueroa, K., Marfo, N. Y., & Eigsti, I.-M. (2022). Parental perceptions of autism spectrum disorder in Latinx and black sociocultural contexts: A systematic review. American Journal on Intellectual and Developmental Disabilities, 127(1), 42–63. https://doi.org/10.1352/1944-7558-127.1.42

Zuckerman, K. E., Sinche, B., Mejia, A., Cobian, M., Becker, T., & Nicolaidis, C. (2014). Latino parents' perspectives on barriers to autism diagnosis. Academic Pediatrics, 14(3), 301–308. https://doi.org/10.1016/j.acap.2013.12.004

 

 

 

 

 

 

 

 

 

 

A Brief Insight Into Autism Diagnosis and Treatment by Christy Yoon, Special Education Trainee

In our rapidly changing world, autism prevalence is also growing. According to the Centers for Disease Control and Prevention’s latest report (2018), approximately one out of 44 children is diagnosed with autism in the United States. This is an increase from 2020, in which one out of 54 children was estimated to have autism. About two decades ago, one out of 150 children was estimated to have autism in the United States. So why are autism rates rising? There could be multiple factors contributing to this growing number. One of the factors is the improvements in awareness and response to autism and efforts being made to reach the underrepresented group.

Figure. Graph representing a steady increase in autism prevalence over the past few decades (Southwest Autism Research & Resource Center. https://autismcenter.org/new-autism-prevalence-rate-released-cdc).

However, despite this improvement and effort, there is still evidence of autism diagnosis and treatment disparities, especially experienced by children with autism or with high-likelihood for autism and their families across racial and ethnic minority groups and in low-resource settings. Recently, a few caregivers of young children with high-likelihood for autism, who were both from minority backgrounds and low-resource settings, shared such challenges. They were experiencing an approximately year-long waitlist for the child’s autism diagnosis evaluation and a lack of resources to receive a diagnosis and appropriate services. The common concern expressed by the caregivers was “wasting away” days, months, and potentially a few years without getting the services for the child and missing the time of optimal impact due to delay in diagnosis. These challenges point to the need to address not only the shortage of expert evaluators for early screening, but also identify services that could be provided for children with high-likelihood for autism during their uncertain wait time for the evaluation.

While the surging prevalence reflects an increasing awareness and response to autism, it also demands improved access, decisions and outcome measures of treatment for autism. As a Korean-American and being part of a Korean community, I have had the privilege of working with many Korean families of children with autism. Often, the caregivers have expressed the experience of “cultural clash” with providers (e.g., early intervention providers, ABA therapists) in regards to developmental milestones and childrearing practices, as well as language barriers resulting in a lack of effective communication and building rapport. Even if the child receives a diagnosis early in life, I recognized that these factors could become barriers to receiving effective treatments and thus impact the outcomes for these children.

These experiences combined have contributed to developing a strong understanding of the need to extend the findings of my research studies to improve access to autism diagnosis and meaningful treatment outcome measures that are culturally responsive.

References

Autism Speaks. https://www.autismspeaks.org/science-news/new-study-shows-increase-global-
            prevalence-

autism#:~:text=The%20global%20increase%20in%20autism,ability%20to%20measure%20autism%20prevalence.

Centers for Disease Control and Prevention [CDC]. (2018). Prevalence of autism spectrum

disorder among children aged 8 years – autism and developmental disabilities monitoring

network, 11 sites, United States, 2014. Morbidity and Mortality Weekly Report, 67(6), 1–

23

Maenner, M. J., Shaw, K. A., Baio, J., Washington, A., Patrick, M., DiRienzo, M., Christensen,

D. L., Wiggins, L. D., Pettygrove, S., Andrews, J. G., Lopez, M., Hudson, A., Baroud, T., Schwenk, Y., White, T., Rosenberg, C. R., Lee, L., Harrington, R. A., Huston, M., et al. (2020). Prevalence of autism spectrum disorder among children aged 8 years — autism and developmental disabilities monitoring network, 11 sites, United States, 2016. Morbidity and Mortality Weekly Report. Surveillance Summaries, 69(4), 1–12. https://doi.org/10.15585/mmwr.ss6904a1.

The Definition of “Normal” in PT By: Ashley O’Donnell, Physical Therapy Trainee

In PT school, it can be difficult to treat a patient’s impairments without conforming to the medical model standards of “normal”. As students, we tend to have tunnel vision, hyper-focused on using a systematic approach when addressing impairments to make up for what we lack in clinical experience. We say we want to “normalize gait pattern”, or ensure children are hitting “normal developmental milestones.” Don’t get me wrong, identifying impairments is essential to helping patients function optimally, but it does beg the question: What does the word “normal” even mean? 

The definition of “normal” should revolve around the patient and his or her individual goals, rather than what is stated by the medical model. Instead of returning to “normal”, PT focuses on a patient’s return to the activities they love. This perspective not only ensures that patients receive individualized care but also eliminates the use of unnecessary comparisons to a standard norm. 

Minimizing the comparison of patient progress to the medical model’s definition of “normal” leaves space for a strengths-based approach. What does the patient do well and enjoy? How can we motivate them with the activities we choose and the strengths-based language we use? These are questions that we can ask ourselves to best serve our patients’ individualized needs.

While I do not believe there is ill intent behind the use of the word “normal”, its use can imply that there is something wrong with having a disability in the first place. As a healthcare professional, it is important to be mindful of the language we use in our practice. It’s inevitable that we’ll all make mistakes as practitioners but being conscientious about how the language we use can affect our patients is essential.

“Normal”...... What is “Normal”??? by Annette Malakoff, Disability Studies Trainee

The pharmacist handed over my prescription for an antibiotic to deal with my yearly

strep, smiled, and said, “This should get you back to normal in no time”.


Though this is not an uncommon phrase, nor was it the first time I had heard it, I

stopped short and gave her a second look. It was then that I realized as a Ph.D. student

of Disability Studies, I have come to understand this word as a judgment and an

idealized state of living - in constant opposition to abnormal. I am immersed in the daily

discourse surrounding the conceptualization of “normal”... But, what is normal? How did

this word come to represent our standard? And was the pharmacist making an innocent

statement… or falling into an ableist assumption of my reality?


Lennard Davis (2013), an international author, historian, and disability scholar

suggests that we live in a world of norms and use it in all aspects of our daily lives as a

measurement to rank intelligence, weight, health, etc. along a contextual line from

subnormal to above average (1). He further explains the history of “norm” originating as

a carpenter’s square to mean “perpendicular” and entering the English language to our

current understanding as “conforming to” or “regular” in the mid-1800s. French

statistician Adolphe Quetelet (1796-1847) applied the astronomer's “average law of

errors” for plotting star sightings to “average human bodies” and then conceptualized

the abstract “average man”. It was here that early statisticians (almost all eugenicists)

applied the “new” representation of the bell curve to the average human body (Davis pp.

4-5). A bell curve, by definition, has extremes with the mean or average in the center

(visual by Dr. Saul McLeod). With the introduction of standard deviation and quartiles,

the bell curve was divided into four sections and attributed with hierarchical low and

high standards. The high standard became our idealized “normal” providing eugenicist

justification of a “pure race” through extermination, and discrimination….and the

opposite extreme became “abnormal” or disabled (Davis pp.4-5).

Visual statistical representation By Dr. Saul McLeod, published in 2019 (A blue bell curve-shaped

mountain, divided into 6 sections labeled as “underperforming” on the far left, “meets expectations” at the

top of the curve, and “excellent performance” to the far right. Human caricatures performing various

activities are aligned with each numerical representation along the “X” axis.

American Disability Studies writer and activist Eli Clare (2017) also positions “normal” in

opposition to “abnormal,” suggesting white Western cultural dominance of worthy over

unworthy, and whole over broken (23). He sees “normal” as a tool for oppression by

which individuals are labeled and tagged without question or hesitation, defining paths

and positions of education, incarceration, institutionalization, and sterilization ( 23).

So then, how do we understand “normal” and why was I questioning the pharmacist’s

statement? The term has become common and is used without a second thought, but it

can also be understood as a bias, exclusionary, and judgemental. Disability Scholars

have questioned the validity of normal, reiterating its instability and fluidity as society

also changes and evolves. Davis further suggests it is the task of Disability Scholars to

create alternatives to and question the construction of normalcy, and not just include

disability as part of normal (12).

As one who identifies as disabled, “normal” will probably always make me turn my head

and wonder…but I write this in hope of a greater understanding of the potential for

negative connotations - and the acknowledgment of my own biases against the word.

Clare, Eli. Brilliant Imperfection: Grappling with Cure. Duke University Press, 2017.

Davis, Lennard J. "Introduction: Normality, Power, and Culture.” The Disability Studies

Reader 4, 2013, pp.1-14.

McLeod, S. A. (2019, May 28). Introduction to the normal distribution (bell curve).

Simply psychology: https://www.simplypsychology.org/normal-distribution.html

Transition Choices by Self Advocate Trainee, Eddie Brown

Hello. My name is Eddie Brown and I’m a self-advocate in the IL-LEND program. I’ve had learning disabilities my whole life, as well as a hearing disability. In school my main trouble is with reading and writing. It has never been easy and still isn’t. My high school teachers only saw my limitations. This really became clear as I was finishing high school and trying to figure out what was next for me. I think this is a common experience for people with disabilities. Either there is no support or there is only support for people who need daily life support. But a lot of us fall between the cracks and don’t have too many choices.

 

The first program that was recommended to me was the ELSA (Elmhurst Learning and Success Academy) program at Elmhurst College. This program is designed to support students who have learning and intellectual disabilities. They offer a lot of support to their students, but I found that a lot of it was too focused on things like consumer skills, independent living and how to interact with others. These were not skills that I needed support with. I felt like I would be back in high school with this program and not reaching my potential.

 

I decided to enroll at Harper Community College. Here I could take college courses, but I found that they couldn’t accommodate my academic needs. So the ELSA program gave me too much support but a community college didn’t give enough. It was a hard time because I knew what I wanted, but I was starting to think that it didn’t exist. I couldn’t be the only person who needed something in the middle.

 

I am very fortunate that I have a family that completely supports me and through their searching they found the Co-Op program at UIC. It gives me the chance to take college course without being separated into a space just for people with disabilities. I can interact with other students in class and they don’t see me as just my disability. At the same time the support I get is personalized to my own needs. One of the best things about the Co-Op program is that I feel like I’m the captain of a winning team. I have people I can turn to with questions about classes, about clubs, about academics and about my future. I’ve never felt so in control of my own choices. They really live by the slogan, “Nothing about us without us”. The Co-Op program is opening up more doors for me than I even knew existed. 

 

The UIC Co-Op program should be a model for other schools to follow and I hope that happens because there are a lot of people like me who struggled to find a place that was just right.

 

To learn more about the Co-Op program, here’s the link: https://ahs.uic.edu/disability-human-development/admissions-and-programs/co-operative-career-experience-certificate/

 

 

 

 

Why Telehealth Access is so Essential in Our Post-COVID World by Physical Therapy Trainee, Zoe Blomquist

As tragic and frustrating as the COVID-19 public health emergency was (and still is), there have been irrefutable advances in the technology realm with massive increases in the use of telecommunication. Many of us were able to continue attending school, business meetings, and doctor’s appointments with the help of videoconference services. Video calls benefited all of us while we maintained social distancing, but the expanded telehealth guidelines for Medicaid and Medicare provided a solution to inaccessibility of facility-based health care appointments. So, what are the major barriers to accessing in-person medical appointments and how can telehealth help?

This image depicts a man sitting on a couch with headphones and a laptop, speaking to a doctor online.

Source: Twistle by HealthCatalyst

Accessing doctor’s appointments via telehealth mitigates transportation issues and expenses. In areas where public transportation is unsafe and runs on a set schedule, it provides a safe and efficient alternative to meeting with healthcare professionals. Additionally, many people with disabilities may require caregiver assistance which necessitates additional coordination. Telehealth can help ease this stress and potentially get people scheduled sooner. For people with social anxiety or that need to avoid busy public places, online appointments are much more accessible. Not to mention, having the option to log-on from the comfort of your own home saves time, especially for those who must travel long distances to attend appointments.

While I can’t speak for all disciplines, I have noticed the benefits of telehealth services in Physical therapy (PT). PT is known to improve mobility and function through a variety of manual interventions, skilled analysis, and individualized exercise. At times this can be difficult to perform wholly via a computer screen, but telehealth can be very beneficial when health issues arise or transportation needs vary. Although telehealth may not be a perfect substitute to an in-person session, it’s a great option to maintain patient-provider relationships and monitoring throughout a plan of care. Medicaid covers telehealth PT in Illinois, but this is not the case in every state. Several bills are awaiting approval to expand telehealth access for a variety of health care providers. Speaking to your legislator about current bills like Expanded Telehealth Access Act (H.R. 2168) and Advancing Telehealth Beyond Covid-19 (H.R. 3030) can allow clinicians to provide telehealth services under Medicare, waive requirements, and expand access to telehealth for mental health services as well.

Benefits of telecommunication that helped so many of us through the toughest times of COVID-19 don’t have to go away as the pandemic decreases severity. The improved appointment access that we saw continues to be essential for people with disabilities and others with health or transportation barriers. Physical therapy services can benefit from improved telehealth access, as can many other healthcare disciplines. Let’s keep healthcare accessible.

A Mom’s Wish….How My Daughter Found her People by Family Trainee, Vicki Borlin

my daughter Tobi performing her ballet solo this July 

I cry when I see my daughter dance. I get looks. But I’ve earned those happy tears. Every mom’s wish, for her kid to fit in, finally came true for me. 

 

My daughter has autism, epilepsy, a rare genetic disorder and numerous other diagnoses. Her disabilities sometimes slow her down. She’s wanted to be a ballerina since she was three and in her head, she knows each move like a professional dancer. But making her body do all of those things is hard for her. 

 

When we put her in dance class as a little one, she fit right in. She wasn’t a prima ballerina but neither were the other girls. As she got older, her inability to do what the other girls were doing grew more obvious. Her last few years, the girls and teachers resented the fact that she couldn’t do the routines perfectly. She was made to feel like a failure. It broke my heart. All she wanted was to dance and to fit in. 

 

Then along came this spunky young teacher named Kati Hassall who had noticed there weren’t many opportunities in our area for kiddos with different abilities in the performing arts. So she started her own not-for-profit studio, Without Limits, and we joined immediately. 

 

Kati treated her like a prima ballerina. She complimented her, gave her tips, taught routines she could do well, gave her confidence. 

 

Then more dancers started coming to classes. And they all had their own challenges. They didn’t care if she spoke to them. They were kind anyway. They hugged her; they danced like her. They didn’t care that she wasn’t perfect.....they built her up! She finally had friends! 

 

Five years later, my girl is on competition cheer and dance teams and performs ballet solos. Her last recital, she was on the stage for five numbers. She has become the dancer she always wanted to be. 

 

And it’s all because one person believed that kids with disabilities could do anything.

To identify or not to identify? That is the question. By Kinesiology Trainee Emily Vaupel

Retrieved from https://dmv.colorado.gov/disability-identifier-for-driver-license/permit/identification-card

As the nation reeled at the death of George Floyd at the hands of police officers in 2020, the little-known death of young man during a 2019 interaction with Colorado police began to come into the public’s awareness. Elijah McClain, a sensitive autistic man, was a massage therapist and a self-taught musician who loved to play music for shelter animals as he believed that they found it comforting. Elijah was a young African American man. When approached by police on August 24, 2019, he stated “I am an introvert, please respect the boundaries that I am speaking.” (BBC News, 2021) Elijah had committed no crime but despite his appropriate request he was physically restrained by police with a now banned chokehold and injected with an overdose of ketamine by paramedics. As a result of the intervention, Elijah died. Had Elijah had the ability to inform the police of his disability would the interaction have ended differently?

Retrieved from https://www.bbc.com/news/world-us-canada-56134565

            To effectively respond to calls involving the disabled, law enforcement needs to be knowledgeable about disabilities along with appropriate disability specific interventions. A 2018 study found that out of officers surveyed, 72.2% had not received autism training (Gardner et al.,2018). A lack of autism or general disability awareness by law enforcement officers has been linked with increased arrest rates and death at the hands of the police. By the age of 28, the disabled have a greater likelihood to be arrested as compared to the nondisabled, with disabled African Americans having an even greater possibility (McCauley, 2017). One third of all police related deaths are disabled individuals. Individuals with neurodevelopmental disabilities and/or mental health disabilities represent the majority of deaths in this group (Diamond & Hogue, 2022).

 

What happens if the disability is an invisible disability?

 

            An invisible disability is a disability that is not visible from the outside and takes the form of a neurological, mental, or physical disability that is not easily identified from first appearance or interaction. Individuals with an invisible disability can appear abled. For example, a deaf person walking down the street with their back to police may not hear a directive and the behavior can be interpreted as noncompliance. In Elijah’s case, he was wearing a ski mask to stay warm while listening to his headphones. He was waving his arms around, which his family believes was him dancing to his music. When Elijah was non-responsive to the police coupled with what the police believed to be erratic behavior (i.e., waving his arm), Elijah was placed in a restraint (BBC News, 2021). What if there had been a way to Elijah to identify his disability to police by showing them his license?

           

            At this time there are two states that provide their residents the ability to have a disability symbol placed on their license or ID card. Alaska Statutes 18.65.310(m) and 28.15.111(d) were passed on May 15, 2017, which allowed individuals to designate on the driver’s license or ID card that they have a disability, visible or invisible (Invisible Disability Designator on an ID Card or Driver’s License, n.d.). Four years later on July 1, 2022, Colorado state instituted an act that “With the signing of HB 21-1014 (Disability Symbol Identification Document Act), Coloradans who might not be able to effectively communicate with first responders due to a cognitive, neurological, mental health, sensory needs, chronic illness, chronic pain and/or physical disability can choose to add a disability symbol identifier to their driver license or ID card to assist them when interacting with the police on their own” (Disability Identifier for Driver License/Permit/Identification Card, n.d.). It is important to note that those who elect to have a disability symbol placed on their license or ID card can have their state remove the symbol later at no cost to them.

 

The disability symbol comes with both advantages and disadvantages. In a time of crisis, an individual can provide first responders with an ID that identifies he/she/they as an individual with a disability. This allows officers the opportunity to reframe the interaction such that they are not dealing with criminal activity but assisting someone with a disability. The best-case scenario is that first responders are knowledgeable of the disability and appropriate interventions. However, having an ID with disability symbol does not ensure direct communication with law enforcement. In a time of crisis, would one be able to be of sound mind to provide the responders with an ID? What if the ID is left at home, does the individual now run the risk of not being treated with respect and dignity because of being unable to legally identify themselves as an individual with a disability? It is important to take into account that law enforcement are not the only ones that will see the disability status on the ID. An individual’s disability status will be visible to anyone who looks at ID (e.g., employer, academic institution, bank, creditor, etc.). Research into whether an invisible disability symbol on a disabled person’s ID correlates with decrease in arrests or death at the hands of law enforcement will be needed to assess the effectiveness of the invisible disability symbol. As Alaska’s and Colorado’s laws are new, it will be several years before this information may be available.

 

References:

 

Invisible Disability Designator on an ID Card or Driver’s License. (n.d.). Retrieved from http://doa.alaska.gov/dmv/akol/designator.htm

 

Disability Identifier for Driver License/Permit/Identification Card. (n.d.). Retrieved from  https://dmv.colorado.gov/disability-identifier-for-driver-license/permit/identification-card

 

Diamond, L. L., & Hogue, L. B. (2022). Law Enforcement Officers: A Call for Training and Awareness of Disabilities. Journal of Disability Policy Studies.

 

Elijah McClain: ‘No legal basis for detention that led to death. (2021, February 2021). BBC News. https://www.bbc.com/news/world-us-canada-56134565

 

Gardner, L., Campbell, J.M. & Westdal, J. Brief Report: Descriptive Analysis of Law Enforcement Officers’ Experiences with and Knowledge of Autism. J Autism Dev Disord 49, 1278–1283 (2019). https://doi.org/10.1007/s10803-018-3794-4

 

McCauley, E.J. (2017). The cumulative probability of arrest by age 28 years in the United States by disability status, race/ethnicity, and gender. American Journal of Public Health, 107(12), 1997-1981. https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2017.304095?casa_token=w2LCtEb_r4QAAAAA:nSWVe5ge1CI-iGMcjBTN5aEmM2jIV2L0dLlhQctrbv7tO3RfNLVehUENfepeZQnCFDSSdmSBzsWU

 

 

 

 

 

Putting the “Therapy” Back into Physical Therapy by Kiley Hunt, PT Trainee

(Image includes a doctor and a patient sitting at a table. The patient is wearing an orange shirt and the doctor is wearing a white lab coat. The patient is talking, and a question mark is above his head, signifying that he is wondering if the doctor is listening. Courtesy of: Ian Conger)

“The other doctors wouldn’t even listen to me.” 

This is a heartbreaking phrase to hear, not only as a clinician, but as a human being. Yet, it is one of the most common phrases I hear as a physical therapy student. People often feel their doctors spend too little time with them or disregard their opinion. Many patients with chronic disability enter rehabilitation clinics frustrated and emotional after feeling unheard for so long. Rehabilitation therapists consistently spend 30 minutes to an hour with their patients, and this often facilitates strong patient-clinician relationships. From my experience, patients feel safe talking to therapists about their physical and mental struggles, and after a few sessions, people often love sharing stories about their personal lives. One of the most memorable physical therapy situations I have experienced was related to a mother bringing in her child who was diagnosed with Cerebral Palsy. She frequently attended sessions with her child, so the therapists had built a positive relationship with her and immediately welcomed her into the clinic. The mother settled in and broke down right away, expressing how overwhelmed she was with her child’s healthcare, bills, and responsibilities. While this made my heart ache for her, the first thing I thought was, “Am I even qualified to give her any advice?”. I had no mental health training and neither had any of the other therapists in the room. We had no way of helping her in any professional way besides referring her to see someone on her own time. 

              In the United States, 1 in 4 people have a disability, and many people will experience some sort of disability in their lifetime, whether it's temporary or permanent. Within this population, adults with disabilities are five times more likely to experience mental distress than adults without disabilities. In 2018, 32.9% of adults with disabilities experienced frequent mental distress, and many studies have shown that these statistics are only on the rise after the COVID-19 pandemic. When it comes to caregivers, studies show that 79% of caregivers of children with intellectual disabilities are at risk for clinical depression. Parenting a child with neurodevelopmental disorders has been shown to correlate with higher levels of anxiety, depression, and stress. Some studies show even higher risks of depression and anxiety in parental caregivers who struggle financially, making lower socioeconomical families at a high risk for mental health concerns. Unfortunately, most individuals with disabilities and their caregivers do not have sufficient access to mental health resources. With the constant doctor appointments, school, and therapy sessions, most people don’t even have the time to schedule appointments with a psychologist. This is especially true for children with disabilities, who must rely even further on their parents' work schedule. Also, the health professionals that people with disabilities interact with on a regular basis often have no mental health training to offer to their patients during treatment sessions, forcing them to find it elsewhere. Lastly, people with disabilities and their parental caregivers are dealt significant medical bills, medical equipment costs, and many other accessibility costs that come with disability such as accessible transportation. So, to expect family caregivers or people with disabilities to spend even more money on mental health services almost feels unfair when they already see so many medical professionals in any given month. 

              All of these reasons reinforce the importance of mental health training for physical therapists. Physical therapy is a career that requires pushing people through their physical struggles, and therapists are often recruited to a person’s medical team after some sort of physical decline or impairment diagnosis. This can be a very emotional time and having a therapist that can work on helping you physically and mentally could be especially helpful. We also know that mental health and physical health go hand in hand. It has been shown that depression increases risks for physical health complications such as diabetes and heart disease. This means that psychological training for physical therapists could not only improve their patient’s overall health, but it could help improve their clinical outcomes as well. This also shows that being able to assist caregivers in their mental health struggles can improve their physical health, which will improve both their quality of life and their ability to continue to care for their child. Overall, mental health is healthcare, and by leaving this out of our treatment sessions, we have forgotten to treat the most important part of each person. In the future, hopefully we can change the catchphrase from “My doctor didn’t even listen to me” to “I have never felt more heard”. 

https://www.cdc.gov/ncbddd/disabilityandhealth/features/mental-health-for-all.html

https://www.abilities.com/community/disabilities-mental-health.html 

https://www.cdc.gov/mentalhealth/learn/index.htm 

https://www.hindawi.com/journals/ijfm/2011/534513/

 

 

Autism in Medical Education- Does it exist? by Medical Trainee, Rebecca Spasari

As a fifth year Child Neurology resident, I am completing my ninth year of medical training after graduating college. While finishing this process and beginning my experience with LEND, I cannot help but think about how difficult it has been to find resources that allow me to prepare for caring for people with disabilities up until this point. During my first year of medical school, after completing a week-long course on cystic fibrosis, a condition that impacts 1 in 3,000 white newborns and is even more rare in non-white populations, we spent an hour learning about both ADHD and autism , conditions that each affect many more individuals. The National Health Interview Survey (NHIS) had the prevalence of ADHD in children 4-17 years old as around 10.2% of the population in 2016 and the CDC reported that in 2018 that the prevalence of autism was 1 in 44 children. I remember angrily googling these statistics at the end of the lecture and feeling so hopeless. I continued searching for the disability education I wanted and found some during my pediatrics rotation. I loved neurology and was planning to care for adults with disabilities with a focus on autism through a neurology residency. I told one of the adult neurology residents this and she responded, “we don’t do that – maybe you should do pediatric neurology.” A brief panic attack followed as it was close to residency application time, but it led me to the pediatric neurologist at my medical school who fortunately had a passion for caring for autistic adults.

 

I came into medical school knowing that I wanted to complete my training and care for people with disabilities, but most people come into medical school not knowing what they want to do and use the training received to pick a specialty. When thinking about the long waitlists to see child neurologists, developmental behavioral pediatricians, and child psychiatrists because of workforce shortages, I wonder if this is because of the way we are taught from our first year of medical school. How would someone develop an interest in autism if they have barely heard about it? I received most of my training on autism in pediatrics rotations and with the child neurologist. It was very clear to me throughout my training that there was a perception that only pediatricians need to know about autism.

There have been studies on trainee knowledge of autism that have shown shocking limitations of graduating medical students and residents. One study at the University of Alabama looked at medical students and pediatric residents and their comfort with caring for a child with autism in an acute care setting. It found that in both pediatric residents and medical students, more than 85% of responders felt less than somewhat informed on management of acute illness in autistic patients. In other words, only 15% of pediatric residents and medical students felt comfortable taking care of autistic patients. There have been other studies based on surveys of pediatric residents, but studies have not focused on the knowledge base of adult practitioners. Based on my experience, I suspect the results would be quite alarming. There have been efforts to create a curriculum for clinicians including the Autism Case Training: Developmental Pediatrics Curriculum which has been piloted in several pediatrics residencies with success. This is very exciting change in the right direction. The next step should be moving this curriculum earlier in training to the medical students so that all future providers will know that no matter what specialty you choose, you need to learn about autism. I think this early introduction can also serve as a form of recruitment to convince medical students to pursue disability focused specialties that have waitlists that last longer than a year.

 

 

References:

1.    AMA J Ethics. 2015;17(4):318-322. doi: 10.1001/journalofethics.2015.17.4.medu1-1504.

2.    Austriaco, Kristine, et al. "Contemporary trainee knowledge of autism: how prepared are our future providers?." Frontiers in Pediatrics 7 (2019): 165.

3.    Dhuga, Yasmin, et al. "Developing undergraduate autism education for medical students: a qualitative study." BMJ paediatrics open 6.1 (2022).