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Friday, December 22, 2017

Why autism remains hidden in Africa

Many African children with autism are hidden away at home — sometimes tied up, almost always undiagnosed. Efforts to bring the condition into the open are only just beginning.

The biggest differences are who gets diagnosed and when. Children with autism in Africa tend to be diagnosed around age 8, about four years later, on average, than their American counterparts. More than half of African children with autism are also diagnosed with intellectual disability, compared with about one-third of American children on the spectrum. This suggests that only the most severely affected children are being picked up: Those who are diagnosed often speak few or no words and require substantial help with everyday tasks such as eating or going to the bathroom. By contrast, in the United States, the largest diagnostic increases over the past few decades have been on the milder end of the spectrum.

Read more here at Spectrum.

Living On The Autism Spectrum: Women Talk About Their Diagnoses As Adults

When we hear the words “autism diagnosis” it’s common to imagine a young child or adolescent.
But what about those who receive their diagnoses at a later stage of life -- in the midst of successful careers or long, happy marriages?

This hour, we meet two women who were diagnosed with autism spectrum disorder as adults.

Listen here.

Tuesday, December 19, 2017

How To: Teach Students to Change Behaviors Through Self-Monitoring

Self-monitoring takes advantage of a behavioral principle: the simple acts of measuring one's target behavior and comparing it to an external standard or goal can result in lasting improvements to that behavior. Self-monitoring is sometimes described as having 'reactive' effects (Kazdin, 1989), because students who measure and pay close attention to selected behaviors often react to this monitoring information by changing those target behaviors in the desired direction.
 
In classroom settings, self-monitoring offers several advantages. Self-monitoring requires that the student be an active participant in the intervention, with responsibility for measuring and evaluating his or her behaviors. Also, in order to accurately self-evaluate behaviors, the student must first learn the teacher's behavioral expectations. That ability of a child or youth to understand and internalize the behavioral expectations of others is a milestone in the development of social skills. Finally, student self-monitoring data is typically economical to collect, even in a busy classroom, and can often be used to document the success of a behavioral intervention.
 
There are many possible variations to student self-monitoring programs.  In order to be most effective, however, self-monitoring programs will usually include the following 7 steps:

Read more here.

Monday, December 18, 2017

Para Supervision Training

Para Supervision Training         unnamed
                          With                                            
                Barb Stimson
      February 22 - Wingate Missoula

This course provides the professional educator with core knowledge and skills to work effectively in teams composed both of professionals and paraeducators. Specifically, participants will refine their knowledge of the characteristics of paraeducators in education, the distinction between professional and paraeducator roles and responsibilities, liability and ethical issues.  This session is a continuation  of  Session I in August of 2017...but participants need not have gone to session I to benefit from this training.  Sessions will be continued at the Summer Institute in June.


If you have queestions about this workshop please contact:
406-847-2236

ADOS-2 REFRESHER TRAINING

                                                 WITH
                          LAUREN SWINEFORD - PHD CCC SLP
                                      FEBRUARY 15,2018
                                    Hampton Inn Kalispell
     
THIS IS A ONE DAY REVIEW OF THE ADOS 2 TRAINING COMPLETE
WITH SCORING PRACTICE AND PRACTICAL QUESTION REVIEW
PARTICIPANTS ARE ENCOURAGED TO SUBMIT QUESTIONS TO DR  SWINEFORD IN ADVANCE FOR DISCUSSION. PARTICIPANTS ARE REQUIRED TO BRING THEIR ADOS MANUALS FOR REFERENCE IN SCORING PRACTICE


              REGISTER HERE . . . LIMITED TO 30 PARTICIPANTS

Please contact Western Montana CSPD with any questions about this workshop.

Cass Rocco
406-847-2236

Tuesday, December 5, 2017

People on the Autism Spectrum Are Boycotting 'To Siri With Love'



People on the autism spectrum are boycotting “To Siri With Love: A Mother, Her Autistic Son, and the Kindness of Machines,” a book written in 2016 by Judith Newman, a mother whose son is on the autism spectrum. In her book, Newman says she wants medical power of attorney when her son, who is currently 16, turns 18 so she can get him a vasectomy.

Read more here at The Mighty.

Monday, December 4, 2017

Mental Health Issues in the Classroom: Practical Strategies for Helping Children and Adolescents Succeed

Missoula - February 21, 2018
Bozeman - February 22, 2018
Billings - February 23, 2018

$200

Course Description:
Join child/adolescent behavioral expert, Jay Berk, PhD, and learn how to best manage the students at your school diagnosed with Oppositional Defiant Disorder (ODD), Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), mood disorders, anxiety and depression. You will walk away with concrete, yet practical, strategies to successfully intervene with their serious behavioral issues, such as:
  • Anger and outbursts
  • Cutting and self-injury
  • Defiance
  • Impulsivity
  • Sensory issues
  • Meltdowns and tantrums
  • Obsessive compulsive
  • Truancy
  • Rigidity
  • Electronic addiction

Through case studies, video clips and dynamic class discussion you will learn:
  • 30 second teacher strategies to manage challenging and disruptive behaviors
  • New ways to reduce the costs of out-of-district placements
  • How to engage students in class, increase productivity and reduce truancy
  • Behavioral assessments and strategies for the IEP team
  • Side-effects of common psychotropic medications
  • How skill deficits from mental health conditions create behavioral difficulties
  • Characteristics of at-risk students’ mental health problems
  • Strategies to gain collaboration with clinicians
Find more information here.

NOTE: This workshop costs $200 and is not provided by the OPI Montana Autism Education Project. We will not offer scholarships because of the cost and not knowing the speaker.

Archived Webinar - Assistive Technology to Support Children’s Sensory and Behavior Development

This workshop discusses the wide range of assistive technology available to help support children’s sensory and behavior needs. Tools, apps, and resources will be discussed and demonstrated.

Watch the recording here. 

Archived Webinar - Staying Organized at Work: Technology Tools for Task Management and Focus

This workshop, for transition-age youth and adults, addresses the use of technology to support task management and focus. Whether you have ADHD or simply struggle with organization, learn about tools and apps to help you succeed at work.

College programs, funding, and other key resources to ensure success

Intellectual disabilities, also known as Low IQ, exist within the larger spectrum of developmental disabilities such as autism spectrum disorder, fetal alcohol syndrome, cerebral palsy and down syndrome. As the number of academic programs for students with these types of disabilities grows, it’s important for learners and their families to have access to details about their options. Read on to learn about various college programs and funding opportunities to support this population of students, and see what our expert has to say about available support services and resources on today’s college campuses.

See the resources here. 

The link between parental age and autism, explained

Older men and women are more likely than young ones to have a child with autism, according to multiple studies published in the past decade. Especially when it comes to fathers, this parental-age effect is one of the most consistent findings in the epidemiology of autism.
The link between a mother’s age and autism is more complex: Women seem to be at an increased risk both when they are much older and much younger than average, according to some studies.
Nailing down why either parent’s age influences autism risk has proved difficult, however.

Cultural barriers lead clinicians to misdiagnose or miss children with autism in immigrant communities.

Gboro and Nabunyi sat on a sofa in the living room of their apartment and watched as the women from a community health clinic offered the toddler various objects. The women’s goal was to observe how Baraka would play with the objects — standard protocol for an autism evaluation. But the protocol seemed geared toward a child with a typical American upbringing. There was a pretend birthday cake, but Baraka had not yet been to an American birthday party. They gave him a plastic bag of Cheerios, the popular American breakfast cereal, but a typical breakfast in the Congo — and in Gboro’s household — is cheese, bread and milk, or sometimes porridge. And there was an African interpreter, too, but he spoke an unfamiliar French dialect and gave the boy instructions with words his parents never used. Sometimes, the clinicians spoke directly to Baraka in English, which he didn’t understand at all.

Those complexities, experts say, make it difficult to interpret the evidence that certain immigrant communities have an unusually high or low prevalence of autism. As some researchers dig into possible explanations, from stress to environmental factors, others say the true issue may be societal: a mix of diagnostic challenges, communication barriers and culture clashes that lead clinicians to misdiagnose or miss children on the spectrum in these communities.

Read more here at Spectrum. 

Teaching Self-management


Self-management interventions help learners with autism spectrum disorders (ASD) learn to independently regulate their own behaviors and act appropriately in a variety of home, school, and community-based situations. With these interventions, learners with ASD are taught to discriminate between appropriate and inappropriate behaviors, accurately monitor and record their own behaviors, and reward themselves for behaving appropriately. As learners with ASD become more fluent with the self-management system, some of the implementation responsibilities shift from teachers, families, and other practitioners to the learners themselves.

Find a short manual here.  

How do adults and teens with self-declared Autism Spectrum Disorder experience eye contact? A qualitative analysis of first-hand accounts

Abstract


A tendency to avoid eye contact is an early indicator of Autism Spectrum Disorder (ASD), and difficulties with eye contact often persist throughout the lifespan. Eye contact difficulties may underlie social cognitive deficits in ASD, and can create significant social and occupational barriers. Thus, this topic has received substantial research and clinical attention. In this study, we used qualitative methods to analyze self-reported experiences with eye contact as described by teens and adults with self-declared ASD. Results suggest people with a self- declared ASD diagnosis experience adverse emotional and physiological reactions, feelings of being invaded, and sensory overload while making eye contact, in addition to difficulties understanding social nuances, and difficulties receiving and sending nonverbal information. Some data support existing mindblindness frameworks, and hyperarousal or hypoarousal theories of eye contact, but we also present novel findings unaccounted for by existing frameworks. Additionally, we highlight innovative strategies people with self-declared ASD have devised to overcome or cope with their eye contact difficulties.

Autism, genetics and epigenetics: why the lived experience matters in research

Epigenetics, in our view, is not a mere replacement of one explanatory model by another one. One does not want to bring back the 'mother blaming' of the 1960s and 1970s. Neither does one want to replace a simplistic single gene explanation of autism by a simplistic single environmental factor, such as, for instance, in the MMR vaccine controversy of the early 2000s. Ethicists and scientists alike should make sure that no black and white conclusions are drawn from epigenetics studies, and that this new field is not simply replacing one culprit (the autism gene) by another (the autism environmental pollutant). In fact, the more nuanced view of human biology that is suggested by epigenetics may help move the discussion from the search for causes and culprits to experiences and understanding.

Who we are and the problems we face are the result of complex interactions of our genetic disposition with our physical and psychosocial environment. As such, problems are never problems of the individual (Barad 2007). For autism, this may suggest a view that a genetic or neurological vulnerability, in combination with environmental factors (both physical as well as psychosocial) can cause the difficulties of autistic people, and that the search for causes solely in the individual itself is doomed to fail.

Walking doesn’t deliver language gains for children with autism

Children with autism do not show the burst of vocabulary growth that usually accompanies learning to walk, according to a new study1.
The findings add to mounting evidence that motor development is linked to social and language skills in children with autism.
Walking gives toddlers an efficient way to explore their environment and initiate social interactions. Studies show that language skills typically blossom after children take their first steps2. Many children with autism have atypical gaits, however. And those who show early signs of motor problems tend to be slow to develop language skills3.
The new work suggests that regardless of when children with autism learn to walk, they do not show the same vocabulary gains that their typical peers do.

Archived Webinar - Giving Instant Feedback to Disabled Students with Technology to Create Engagement and Motivation

Instant feedback corrects mistakes at the earliest possible moment and motivates students in the academic setting. Instant feedback can help alleviate some of the frustration that disabled students feel and reinforce positive learning behaviors. Attendees will learn about several technologies that will considerably increase the engagement of students with disabilities and other challenging learners. 

This webinar will explore several online student response systems. Some of the programs that will be explored are Kahoot!, Socrative, Quizlet, and Plickers. The psychology of instant feedback and the positive effect it has on students with disabilities will be discussed along with the use of the technology.

View the recording here. 

Archived Webinar - AAC Implementation Plans: Preparing for Successful Communication

In this session, we will discuss how to develop and utilize an Augmentative and Alternative Communication (AAC) Implementation Plan to support communication across activities or settings. Crucial components include descriptions of tools and strategies used with an individual, detailed communicative expectations for specific activities across an individual's day, and determination of team members' various responsibilities regarding the AAC system.

An AAC Implementation Plan can be used as a framework for team discussion, a training resource, and a launching point for data collection.

Watch the recording here. 

‘I Thought I Was Lazy’: The Invisible Day-To-Day Struggle For Autistic Women

My inability to properly plan ahead and complete daily tasks has dwarfed my personal growth and well-being since I moved away from home seven years ago. I live in a constant state of disorder, expressed through missed appointments, forgotten text messages, and errands and assignments that take twice as long than my peers to complete. Even tidying the garbage littered across my apartment feels too overwhelming. My poor organizational and cleaning skills have fractured my relationships, prevented me from thriving in jobs, and in the process, destroyed my self-worth.
I tried various planners and organizational apps. Nothing worked. Frustrated, I reached out for help multiple times, relaying to various therapists my struggles with organization and cleanliness and other ailments — such as insomnia, a tendency to get lost in obsessive thoughts, and an inability to switch between tasks. Not one specialist connected the dots. They viewed disorganization and forgetfulness as easily amendable, and never searched for the source of my struggles.

Monday, November 20, 2017

Race, class contribute to disparities in autism diagnoses

The prevalence of autism continues to increase across the United States, regardless of socioeconomic class, according to a new study1. Overall, black and Hispanic children are less likely than their white peers to have an autism diagnosis.
The findings highlight persistent racial disparities in autism prevalence: White children are about 19 percent more likely than black children and 65 percent more likely than Hispanic children to be diagnosed with autism.
Autism prevalence in the U.S. has more than doubled since 2002. Researchers have looked to changes in the condition’s diagnostic definition and greater awareness among parents as possible explanations for this rise.
They have also assumed that access to good schools and medical care would explain much of why white children and those of high socioeconomic status are more likely than black and Hispanic children and those of low socioeconomic status to be diagnosed with autism.
The new study upended many of these assumptions.
The findings suggest that socioeconomic status doesn’t fully explain the differences in prevalence across race and ethnicity.

Tuesday, November 7, 2017

Portrayals of autism on television don’t showcase full spectrum

If you’re a fan of either of two new television shows that debuted in the United States this September — “Atypical” on the streaming service Netflix or “The Good Doctor” on ABC  I’ve got news for you. You’re watching an overly positive depiction of autism that doesn’t reflect reality for the majority of people on the spectrum.
To the TV-watching public, autism has come to mean the verbal, higher-skilled, savant end of the spectrum, because individuals at that end make for interesting characters.

Saturday, November 4, 2017

Smart Shop: Identifying the Evidence-Based Practices in Commonly Used Curriculum



In this edition, we’ll continue to explore sessions from the Communities of Leaders in Autism (CoLA) Summer Institute. This month’s presentations cover EBPs, or evidence-based practices!

Sue Palko, Region 1 Autism Program Coordinator, and Karen Berlin, Training and Technical Assistance Center at George Mason University, presented Smart Shop: Identifying the Evidence-Based Practice in Commonly Used Curriculum. This presentation reviewed the importance of relying on scientific behavior knowledge and evidence-based practices when selecting and using curricula for instruction of learners with autism spectrum disorders and examined available tools to help educators determine if commercial products and curriculum are a “right fit” for their students. While no ASD specific tool for this purpose has yet been developed, school division leadership and educators can use the following tools to inform and guide their selection and decision making processes:

Hexagon Tool: The Hexagon Tool helps states, divisions, and schools systematically evaluate new and existing interventions via six broad factors: needs, fit, resource availability, evidence, readiness for replication, and capacity to implement.

Selection of Evidence Based Practices Tool: This Virginia Tiered Systems of Support selection tool provides guiding questions to help stakeholders determine if an intervention will be a “right fit” for its intended purpose within a division or school.

Virginia Commonwealth University Autism Center for Excellence, (VCU-ACE): Based on the skill competencies for professionals supporting individuals with ASD across the lifespan, this website provides on-line training, resources, and links to training information on EBPs listed by NPDC (below) and the National Autism Center.
National Professional Center for ASD: This website maintains resources and information on specific evidence-based practices for ASD and provides free access to AFIRM online modules and resources for each of the 27 EBPs.

National Autism Center: This website houses the “National Standards Project” report which provides qualitative analysis and guidance about which interventions have been shown to be effective for individuals with ASD.

Autism Internet Modules: This website provides 45 free on-line training modules on evidence based practices for learners with ASD.
Other web-based resources to guide an educator’s selection of academic instructional resources and curriculum:

Tuesday, October 31, 2017

Archived Webinar - School districts using QIAT to improve assistive technology services

The Quality Indicators for Assistive Technology Services (QIAT) describe the characteristics of high-quality assistive technology services as they are provided in school settings. The eight service areas include: Consideration of AT Needs, Assessment of AT Needs, AT in the IEP, AT Implementation, Evaluation of Effectiveness of AT, AT in Transition, Administrative Support for AT, and AT Professional Development. For more than 15 years the indicators have been used in a variety of ways to assess assistive technology services and guide improvement efforts.

Session 2: How can the QIAT help school districts as they work to offer high quality assistive technology services aligned to federal, state and local mandates? How can QIAT be used as a tool for assistive technology service providers as they evaluate and work to continually improve their services? This session will address these questions and offer many examples of ways that QIAT has been used at a school-district level.

Find the recording here. 

Archived Webinar - Customized Employment - Opening Doors for People on the Autism Spectrum

This webinar will provide an overview of the customized employment process including its utility in facilitating competitive, integrated employment outcomes for people with complex disabilities such as autism. Success stories and information about integration of customized employment strategies into vocational rehabilitation systems will be presented.

View the archived webinar here (takes a minute to load.)


Monday, October 30, 2017

Autism prevalence and socioeconomic status: What's the connection?

Children living in neighborhoods where incomes are low and fewer adults have bachelor's degrees are less likely to be diagnosed with autism spectrum disorder compared to kids from more affluent neighborhoods.
The finding is part of a new multi-institution study of autism spectrum disorder (ASD), led by Maureen Durkin of the University of Wisconsin-Madison's Waisman Center, and published recently in the American Journal of Public Health.

Archived Webinar Series - Autism: Research & Medical Treatment Implications

Webcasts - view here at the Cleveland Clinic

Judy Van de Water, PhD
Estimated Time:   45 minutes
Release Date:   August 14, 2017
Expiration Date:  August 14, 2019
Type: Webcast
Specialties: Neurology, Pediatrics, Family Medicine, Gastroenterology, Pathology, Internal Medicine
Judy Van de Water, PhD
Estimated Time:   30 minutes
Release Date:   August 14, 2017
Expiration Date:  August 14, 2019
Type: Webcast
Specialties: Neurology, Pediatrics, Family Medicine, Gastroenterology, Pathology, Internal Medicine
Lauren Moskowitz, PhD
Estimated Time:   30 minutes
Release Date:   September 26, 2017
Expiration Date:  September 26, 2019
Type: Webcast
Specialties: Neurology, Pediatrics, Family Medicine, Gastroenterology, Pathology, Internal Medicine
Lauren Moskowitz, PhD
Estimated Time:   15 minutes
Release Date:   September 26, 2017
Expiration Date:  September 26, 2019
Type: Webcast
Specialties: Neurology, Pediatrics, Family Medicine, Gastroenterology, Pathology, Internal Medicine

WHAT PUTS YOUTH WITH AUTISM AT RISK FOR BEING HOSPITALIZED?

Children and teens with autism are more likely to be hospitalized for psychiatric care1than their classmates. If we understand why, researchers ask, can we take steps to prevent their problems from reaching that point?
A new study outlines five factors that increase the risk of a psychiatric hospital stay in youth with autism spectrum disorder (ASD). They include, in decreasing order of risk, having:
  • a mood disorder (such as depression, bipolar disorder, or disruptive mood dysregulation disorder)
  • current sleep problems
  • more severe autism symptoms,
  • poor "adaptive" (or everyday living) skills
  • a single-parent household.2
This study is among the first published from researchers in the Autism Inpatient Collection (AIC). The U.S.-based project aims to learn more about youth, ages 4 to 20, who are admitted to one of six in-patient psychiatry units that specialize in developmental disorders. (Youth with autism who are patients on general psychiatric units are not included in this project).
About 1 in 10 youth with autism are admitted to a hospital for mental health care.3 Studies like this one may help lead to better care and prevention of the behavioral crises that land youth in the hospital.

Workshop - A Guide to Managing Challenging Behaviors

December 6 (8:00AM to 4:00PM)Hampton Inn (Great Falls)

December 7 (8:00AM to 4:00PM)
Fifth Avenue Christian Church (Havre)


6 OPI Renewal Units
Cost is free


The Guide to Managing Challenging Behaviors training involves an in-troduction to broad-spectrum behavior analysis in the form of the Pyramid Approach to Education. Discussion focuses on the importance of addressing students’ skill deficits prior to or simultaneously with ad-dressing behavior excess or other unwanted behavior is explored. In ad-dition, issues related to teaching skills are addressed. This workshop teaches participants to determine and define unwanted behavior targeted for intervention. Participants are assisted with understanding the func-tional assessment of behavior, and the selection and teaching of alterna-tive responses to replace unwanted behavior. Participants are exposed to antecedent strategies designed to reduce unwanted behavior as well as differential reinforcement procedures and consequence based strategies. Finally, issues related to the evaluation and monitoring of behavior plans are discussed.

Registration LINK

For more information contact Aileen Couch, Region II CSPD Coordinator, at cspd@blueponyk12.com or call 406-395-8550 (ext. 6714).


Transition Workshop: "Integrating Employability Skills: Improving Transition to Employment for Students with Disabilities"

(Dr. Tessie Rose Bailey, Presenter)

November 29 (9:00AM to 4:00PM)


Willson School
404 West Main, Bozeman
6 OPI Renewal Units
Cost is free
Stipend available

Students with disabilities require many skills for post-school success, including academic knowledge, technical expertise, and a set of general, cross-cutting abilities called employability skills. The U.S. Department of Education, through an initiative of the Office of Career, Technical, and Adult, developed the Employability Skills Framework in an effort to clearly identify the general skills necessary for success in the labor market at all employment levels and in all sectors. 

This interactive session will:
  • Introduce participants to the Employability Skills Framework and explain why it is important for students with disabilities 
  • Connect employability skill preparation to transition plans and lesson planning. 
  • Provide tools and strategies to select appropriate assessments and prioritize employability skills at the employer, district, and individual teacher levels.  
The session is relevant for special and general educators, career and technical educators, and vocational rehabilitation staff.

Flyer LINK

Registration LINK (Course #9951)

Provided by Region IV CSPD

Transition Workshop: "Evidence-Based Instructional Strategies for Transition Training"

(Dr. Tessie Rose Bailey, Presenter)

November 28 8:30AM to 4:00PM)

Willson School
404 West Main, Bozeman

6 OPI Renewal Units
Cost is free
Stipend available


Looking for what works in transition planning? This interactive session will present validated approaches for transition assessment, instructional delivery, and data collection/analysis processes. In addition to modeling several evidence-based instructional strategies, this session will also demonstrate how educators can use existing resources to identify appropriate transition activities.


By the end of this session, participants will be able to:

• Use existing resources to identify evidence-based practices in transition services and planning
• Describe the components of three common evidence-based transition practices used in schools programs
• Design and implement a transition-based education for students with disabilities The session is relevant for educators responsible for supporting the development and implementation of transition programs. Although not required, participants are encouraged to bring samples of their own transition plans for activities.

Flyer LINK
Registration LINK (Course #9952)

Data do-over backs dominance of genetics in autism risk

A reanalysis of data from more than 2 million children in Sweden suggests inherited genetic factors account for 83 percent of autism risk1.
A 2014 study using the same dataset pointed to an equal contribution from genetics and the environment, but experts in the field were critical of the findings, citing flaws in the study’s methods.
Then, to their surprise, the researchers came up with a heritability estimate of 85 percent using an overlapping dataset of nearly 800,000 Swedish children2. That result prompted them to revisit their earlier work.
In both studies, non-inherited genetic factors called de novo mutations are included in the 17 percent of autism risk dubbed ‘environmental.’ De novo mutations are thought to be important in autism.

Late birth linked to risk of autism with intellectual disability

Lee and his colleagues analyzed data from 480,728 individuals in the Stockholm Youth Cohort, an ongoing study of children born between 1984 and 2007 in Stockholm, Sweden. Of the roughly 2 percent of children diagnosed with autism, 2,368 have autism with intellectual disability and 7,657 have autism only.
The prevalence of autism is highest — 52.4 per 1,000 — in babies born at 27 weeks of gestation. The rate goes down every week until 40 weeks, when it stands at 19.8 in 1,000. It picks up again in children born between 41 and 43 weeks, when it peaks at 23 in 1,000.
The preterm pattern is similar for children who have autism alone and those who have autism with intellectual disability. But postterm, only the rate for autism with intellectual disability rises significantly, and the rise is small: from 4.6 to 6.2 per 1000 children. The findings were published 12 September in Paediatric and Perinatal Epidemiology.