Birth Experience Linked With Autism

Researchers searching for the causes of autism beyond genetics have identified another possible influence—whether or not the child's mother underwent procedures to induce or speed up labor.

Health care providers induce or augment labor to help mothers who have health conditions that could be detrimental to them or their child.

According to a study published in the journal JAMA Pediatrics, children—particularly males—born to mothers who were induced and augmented, induced only, or augmented only experienced increased odds of autism compared with children born to mothers who received neither labor induction nor augmentation. Researchers controlled for a variety of factors, including socioeconomic status, maternal health, pregnancy-related events and conditions, and birth year.

Males born in deliveries in which labor was both induced and augmented were 35 percent more likely to have autism than those whose mother did not have either of these treatments. For induction alone, risk was elevated 18 percent, and for augmentation alone, risk went up 15 percent.

The risk to females was not significantly elevated when labor was both induced and augmented, or induced alone. The likelihood of autism went up 21 percent with augmentation alone.

The study also found support for other previously established autism risk factors: Older maternal age (a 30 percent higher risk), being first born (21 percent higher), and the mother's gestational diabetes (24 percent).

The investigation, which examined the birth and education records of more than 625,000 children from North Carolina, does not indicate that labor-related treatments cause autism. And although researchers had information on the demographics of both parents, the mother's medical history and age at pregnancy, and infant health, they did not have other important information, such as paternal age, maternal medications or the severity of the child's autism spectrum disorder.

Feds Target Providers Who Stop Therapy Just Under the Threshold

Outpatient therapy providers who discharged Medicare patients just before the patients reached the $3,700 threshold that triggers automatic medical review are receiving letters asking for additional documentation of those services.

A supplemental review contractor for the Centers for Medicare and Medicaid Services will use the additional documentation to determine the medical necessity for the services.

The claims review period referenced in the CMS letters is October 2012 through March 2013. During this period—the initial period of manual medical review—providers were allowed to request pre-approval of services beyond the threshold by sending CMS documentation of medical need. If a provider did not seek prior approval, the claims were subject to post-payment manual medical review.

Although the nature of the review was not specified, providers who stopped therapy at or near the cap, then resumed during a new benefit period, are subject to the medical necessity review. The review likely targets providers who believed that stopping treatment and waiting to begin again in a new benefit period was saving the beneficiary money—the out-of-pocket expense of treatment beyond the threshold—and shifting the costs back to Medicare.

Appeals Court Rules That IDEA Compliance Does Not Equal ADA Compliance

Two students with hearing impairments will get a second chance to show that their California school districts violated Title II of the Americans With Disabilities Act by denying their requests for word-for-word transcription service in the classroom. The 9th U.S. District Court of Appeals reversed two district courts' judgments, saying that the school districts' compliance with the Individual With Disabilities Act did not necessarily demonstrate compliance with Title II of the ADA [PDF].

The plaintiffs, high school students with hearing impairment who received special education services under IDEA, alleged that their school districts had an obligation under Title II of the ADA to provide them with a word-for-word transcription service. The district court reasoned that a valid individualized education program under IDEA satisfies a Rehabilitation Act Section 504 regulation requiring schools to offer children with disabilities a free, appropriate public education; therefore, because Title II and Section 504 are substantially similar statutes, the IEP also satisfies Title II.

The appeals court rejected that reasoning, indicating that IDEA compliance does not automatically satisfy Section 504, and that ADA requirements regarding students with hearing impairment are different than those imposed by IDEA. The panel reversed the grants of summary judgment on the ADA claims in both cases and remanded both cases for further proceedings. 

Australian Database Helps Clinicians Make Evidence-Based Treatment Decisions

Clinicians looking for help making evidence-based clinical decisions can turn to speechBITE, an evidence-based practice initiative of Speech Pathology Australia and the University of Sydney.

speechBITE (the Speech Pathology Database for Best Interventions and Treatment Efficacy) is a free, searchable online database of peer-reviewed published treatment research for the entire scope of speech-language pathology. speechBITE provides the citations and, where possible, the abstracts for these references.

Studies on this database include systematic reviews, randomized controlled trials, non-randomized controlled trials, case series and single-case experimental design. Methodological ratings allow users to discern the scientific quality of each research study. To be included, studies must be published in a peer-reviewed journal, include an intervention relevant to speech-language treatment, include participants with (or at risk of) a communication and/or swallowing disorder, and provide empirical data on treatment efficacy. Currently, speechBITE has more than 3,700 references across all levels of evidence, with new references added regularly.

speechBITE will soon upgrade its site with a new design, layout and information; upgraded search functions; and new sources of evidence, including clinical practice guidelines. The launch of the new site will take place at the 2013 ASHA Convention in November.