Understanding The Significant Impact of Poverty on Autism

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Neurology, Poverty & Autism

Areas impacted the most by poverty include (Marston, 2013):

Hippocampus Amygdala Prefrontal cortex

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”

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)

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

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)

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)

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

BHRS Services (continued)

Coordination between behavioral health and other services

Can start at an early age for children with autism

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

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

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

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

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

Obtaining Employment (continued)

Training programs that target job tasks, acclimation to the job and social integration

Extensive and long-terms support from job coaches

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

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

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