National Autism Awareness Month

For over 50 years the Autism Society has provided services and programming to support individuals living with autism. National Autism Awareness Month, observed every April, has been an occasion to promote awareness of autism and work to ensure that each person with autism spectrum disorder (ASD) can achieve the highest possible quality of life.  

Autism spectrum disorder is a complex developmental disability that affects a person’s ability to communicate and interact with others. Signs of autism, which usually appear early in childhood, are: delayed learning of language; little or no eye contact with other people; lack of interest in peer relationships; lack of spontaneous or make-believe play; fixation on particular objects; difficulty with executive functioning (which relates to reasoning and planning); narrow, intense interests; poor motor skills; repetitive use of language; repetitive movements (such as hand-flapping); and sensory issues. ASD is a “spectrum condition” that affects individuals to varying degrees. A diagnosis of autism spectrum disorders reflects the number and severity of these behaviors a person shows. 

In 2016, the Centers for Disease Control and Prevention reported that the prevalence of autism in the United States was 1 in every 68 births, and 1 in every 54 boys. The overall prevalence in 2016 was twice the rate in 2004, which was 1 in every 125 births. Autism services cost U.S. citizens $236 to $262 billion annually. Most of this amount is for adult services—$175–$196 billion, compared to $61–$66 billion for children. Cost of lifelong care can be reduced by two-thirds with early diagnosis and intervention.  

Autism is treatable. Studies show that early diagnosis and intervention can change lives. Intervention plans must be unique to the individual, but they usually involve behavioral treatment, medicines, or both. Early behavioral treatment requires intensive collaboration between a child’s family and a team of professionals and may consist of parent training and individual therapy in a special center or classroom. Many people with ASD have other associated medical conditions, such as sleep disturbance or seizures, and improving these conditions can improve attention, learning, and behavior. Different interventions are needed as a child develops and acquires social and learning skills—for example, specialized social skills training may be help children with autism when they enter school. Adolescents with autism can benefit from supportive services that help them transition to employment and independence as adults.  

According to Autism Speaks (www.autismspeaks.org), a small minority of people with ASD progress to the point that they no longer meet the diagnostic criteria for autism. These individuals may have been misdiagnosed, may have “matured out” of some symptoms, or may have responded especially well to treatment. Some individuals have the “best possible outcomes”; their test scores are within normal ranges for IQ, language, functioning, school placement and personality, but they still have mild symptoms on some personality and diagnostic tests.  

This April, the Autism Society also wants to encourage people and groups to become partners in a movement toward accepting and appreciating people with ASD and including them in our schools and communities in a way that reflects true appreciation of the unique qualities of all people. “We want to get one step closer to a society where those with ASDs are truly valued for their unique talents and gifts,” says the Society’s website. 

Black Youth and Suicide

Suicide rates among black youth have never been higher than they are now. A 2016 CNN report indicates that the suicide rate among young black boys, ages 5 to 11, has nearly doubled within the past two decades. The increase was large enough to raise the “deaths due to suicide” rate among all black children from 1.36 to 2.54 per million. Hanging and suffocation are the most common suicide methods in black boys, accounting for 78% of all suicide deaths. Shooting is the second most common method of suicide and accounts for more than 17% of the cases.

Causes of the increase remain unknown, but the National Alliance on Mental Illness (NAMI) reports that black youth are more likely to be exposed to violence and trauma than other children, and those stressors have been linked to suicidal behavior. Black youth are also less likely to receive services for mental health issues, such as depression and suicidal tendencies, than other youth. NAMI also reports that the shame and stigma associated with mental health issues within the black community may be a reason for the lack of treatment.

Undoing the stigmatization of mental health care is an ongoing challenge in the black community. Addressing mental health stigma and ensuring appropriate, proper care for black boys who are suicidal or exhibiting warning signs is crucial in the reduction of suicide rates. Some health care professionals have begun to reframe conversations about mental health to remove clinical labels and contour conversations to reflect positive themes within communities of color. Jessmina Archbold, a social worker and mental health advocate in New York, suggests that it is imperative to educate white mental health care professionals about how to engage communities of color. She has coined her reframed approach as a “strength-building process” as opposed to treating an “illness.”

Adults who deal with children, including parents and teachers, must be trained to recognize the warning signs of suicide and know how to intervene properly. All threats and talk of suicide by children and youth should be taken seriously.

According to the American Association of Suicidology, the following behaviors or symptoms may signal a suicidal crisis in a young person:

  • Feelings of hopelessness
  • Anxiety, agitation, trouble sleeping or sleeping all of the time
  • Expressions of having no reason for living or no sense of purpose in life
  • Feelings of being trapped, like there’s no way out
  • Increased alcohol and/or drug use
  • Withdrawal from friends, family and community
  • Rage, uncontrolled anger, expressions of wanting or seeking revenge
  • Reckless behavior or more risky activities, seemingly without thinking
  • Dramatic mood changes
  • Giving away prized possessions

More research is needed to explain the factors involved in the increased rates of suicide among young black boys. Adults are encouraged to talk to young children about mental health, emotions, and suicide. Research has dispelled the idea that asking children directly about suicide will trigger suicidal thinking or behavior.

Bizzell Group: Addressing Suicide Prevention

The Bizzell Group (Bizzell) continues to demonstrate a strong commitment to advancing and assisting in substantive public discourse around suicide and suicide prevention. Through various contracts, Bizzell works with organizations, Federal clients, non-profits and partners to make an impact with the hope of reducing suicide rates across the country. Some of Bizzell’s work in the area of suicide prevention includes: American Indian and Alaskan Native suicide, military suicide and Arctic region suicide.

The American Indian/Alaskan Native communities have strikingly higher rates of suicides than the overall population in the U.S. The Indian Health Service identifies suicides as the second leading cause of death among AI/AN youth (5 and 24 years old). These AI/AN adolescents are also at greater risk for suicide contagion and suicide clusters, which can be particularly devastating for the often close-knit and rural AI/AN communities. Bizzell examined the research on suicide clusters and contagion in general and within AI/AN communities.

In addition to researching rates of suicide among American Indian/Alaskan Native populations, Bizzell has supported suicide prevention efforts among Veteran and Service member populations. According to a recent study by the Department of Veterans Affairs, roughly 20 veterans a day nationwide commit suicide. Researchers concluded that veterans are at a 21 percent higher risk for suicide than civilian populations. In 2014, the latest year available, more than 7,400 veterans took their own lives, accounting for 18 percent of all suicides in America. Veterans make up less than 9 percent of the U.S. population. Military suicide also has a significant impact on the family members left behind. The University of Southern California found “that military connected adolescents have a higher rate of suicidal thoughts than their civilian counterparts, and other studies indicate that military spouses— particularly those serving as caregivers to support their wounded veterans—are more at risk to suffer mental health problems.” The untold costs of military service on family members is difficult to measure. The National Military Family Association, a nonprofit that serves a quarter of a million military relatives, reported “hearing about an increasing number of stories about family members killing themselves.”

Bizzell recognizes that high suicide rates are not limited to American Indian/Alaskan Native populations or military communities; suicide rates in the Arctic are among the highest in the world. Historically, indigenous people in circumpolar regions had very low rates of death by suicide. However, there is currently no other region that suicide has had such a strong impact and social burden on than in indigenous populations—specifically those in circumpolar regions. The World Health Organization (WHO) estimates that suicide accounts for roughly 800,000 deaths per year worldwide—although rates differ within countries according to geography,gender, ethnicity and cultural variables. Greenland and the arctic regions of the United States, Canada and Russia have considerably higher suicide rates than the non-Arctic Regions, and where data is available by ethnicity (Alaska, Canada and Russia), the increased risk of suicide in indigenous communities is evident. Bizzell is assisting RISING SUN, an initiative under the U.S. chairmanship of the Arctic Council that is designated to identify a toolkit of common outcomes to be used in evaluating suicide prevention efforts to assess the key correlates associated with suicide prevention intervention across Arctic states. The goal is to generate shared knowledge that will aid health workers in better serving circumpolar communities, and help policymakers measure progress, evaluate interventions, and identify regional and cultural challenges to implementation.

Bizzell Develops Medscape Article on the Interactions Between Dementia, Diabetes and Cardiovascular Disease

The Bizzell Group (Bizzell) has recently developed an article, published on Medscape, which explores the interactions between dementia, diabetes, and cardiovascular disease.  The article, Bidirectional Impact of Alzheimer’s Disease and Common Comorbid Conditions, is available as an online CME activity and was developed under a contract with the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA) in collaboration with the HHS, Office of Women’s Health.

It is intended for primary care providers, neurologists, psychiatrists, geriatricians, and other health care team members and addresses the complexities of treating patients with Alzheimer’s disease and common coexisting conditions, specifically cardiovascular disease (CVD) and diabetes (T2D).

These comorbidities can impact the severity and progression of the disease and require individualized, patient-centered approaches and thoughtful medical reasoning. The module discusses common challenges and considerations in the identification, diagnosis, and treatment of patients with Alzheimer’s disease and T2D or CVD.  Useful diagnostic tools, guidelines, and patient resources are provided.