Author: Antonia

All recent presidents have employed executive orders to fulfil campaign promises and send signals to their supporters. Joe Biden has issued more executive orders in his first days in office than any modern president, and many of his orders have been employed to signal to those on the left of his party that he is listening to their concerns. Chief among them is his “Executive order on preventing and combating discrimination on the basis of gender identity or sexual orientation”, which set off a Twitter firestorm with the hashtag #BidenErasedWomen. Organisations of the left committed to women’s rights have joined prominent voices on the right to condemn the new president’s move “to gut sex anti-discrimination laws and eliminate critical protections for women in the federal government”.

Read more at The Critic.

How many people have died of Covid-19? The answer, one might imagine, can be found at the ‘global dashboard’ updated hourly by Johns Hopkins University using publicly available data. Government departments and agencies supply much of the data. Most publish daily updates, such as the UK summary, and cumulative trackers such as that maintained by the US Centers for Disease Control and Prevention (CDC). The numbers are striking because they are large and presented out of their natural context. Although we are now familiar with the notion of excess deaths, how many of us know the usual annual number of deaths in our own countries?

Read more at The Critic.

The Blue Öyster Cult, whose public health advisory ‘(Don’t Fear) the Reaper’ still plays in heavy rotation on many US radio stations, botched the daily death rate in the USA. Not 40,000 men and women everyday, nor even 10,000, but a little over 5200 in 1976 – a total of 1,909,440 people died in that leap year – when the track was released, and about 8000 in each of the past three years.

The confirmed CDC figure for 2018 was 2,839,205 deaths in the USA. That was almost a million more than in 1976, but at 8.7 per 1000 people, the general mortality rate has dropped fractionally (from 8.9/1000) in 45 years. In 2019, the provisional total number of deaths was rounded to 2,855,000 (compared to 3,748,000 live births). As of 29 December, provisional data compiled by the Centers for Disease Control and Prevention (CDC) suggest that at least 2,882,500 people have died in the USA in 2020. We can expect the number to increase when the tally is updated in January, and afterwards as delayed death certificates are processed and reported. But by how much?

General data on live births and deaths to the end of June 2020, which captured the first peak of Covid deaths in April and May, suggest the running twelve-month total of deaths in the USA had ticked over 3 million. With an increase in Covid infections and deaths in the last two months of the calendar year, it likely that final figure for 2020 will exceed that, but will be within 10-12% of the usual annual total. This is a large anomaly. The pressing question is, therefore: Can these excess deaths be attributed to Covid-19? Another question is: Should all of these deaths be attributed to Covid-19? The answers are not the same, as I shall explore in another article.

About 10% of 2020 death certificates in the USA have recorded Covid-19 as a cause of death. The formal CDC designation is ‘Deaths with confirmed or presumed COVID-19, coded to ICD-10: U07.1 (COVID-19, virus identified) and U07.2 (COVID-19, virus not identified)’. ICD-10 is the tenth edition of the WHO’s ‘International Classification of Diseases’. CDC reports that ‘For the majority of deaths where COVID-19 is reported on the death certificate (approximately 95%), COVID-19 is selected as the underlying cause of death’. This is a very high percentage – 95% is far higher than in the UK, where the number is closer to 70% – which would only make sense if it were the percentage of people who were hospitalized with severe Covid and subsequently died. However, for reasons that I have set out elsewhere, it includes deaths in every other setting, even where there is no confirmed case of Covid.

Beyond the specifics of death certification, a fierce debate has raged in the USA about whether Covid deaths have been inflated for reasons of politics and profit. The CARES act, passed with strong bipartisan support in the US Congress and signed into law in March, including provisions that guaranteed generous and prompt payments to hospitals and other healthcare providers for all Covid patients they treated, regardless of whether those patients possessed health insurance, or indeed whether they actually had a confirmed Covid diagnosis. According to the CDC’s own guidelines, presumptive Covid and confirmed Covid were to be considered the same for billing purposes. ‘The provider’s documentation that the individual has COVID-19 is sufficient’ and no further proof was needed.

Similarly, billions of dollars were distributed under the terms of the CARES act to nursing homes and other residential care facilities specifically for Covid-related activities. In a system that bills for healthcare services upon delivery the guarantee of ‘free healthcare’ for, and only for, Covid patients, the CARES act and CDC guidelines together created a perverse incentive to inflate Covid numbers.

It is clear that many more people have died this year than should have died. But they did not all die of Covid, and many died because of the response to Covid rather than the disease itself.

A viewpoint article published on 17 December in the Journal of the American Medical Association threatens to set a new standard for saying very little about Covid urgently. COVID-19 as the Leading Cause of Death in the United States establishes clearly that between March and October 2020, Covid did not achieve the status of ‘Leading Cause of Death in the United States. However, it shrieks, ‘The daily US mortality rate for COVID-19 deaths is equivalent to the September 11, 2001, attacks, which claimed 2988 lives, occurring every 1.5 days, or 15 Airbus 320 jetliners, each carrying 150 passengers, crashing every day’.

The table accompanying the article compares deaths attributed to Covid between March and October 2020 with deaths in the same nine-month period in 2018. The table shows that Covid has been one-eighth as deadly for those aged 25-34 as accidental drug overdoses, about half as deadly for those aged 45-54 as heart disease, and around a third as deadly for those aged 55-64 as cancer. Children under 15 die in plane crashes as surely as adults, but they have a one in a million chance of dying from Covid. Although, slightly more Americans aged 85 or older died of Covid than cancer, those deaths together still did not approach the total of the very elderly who died of heart disease.

Although there were no Covid deaths in 2018, the comparison between Covid deaths in 2020 and other causes in 2018 is explained by the fact that 2018 is ‘the most recent year for which detailed cause-of-death data are available’. This reminds us that we do not have reliable data for all causes of death in 2020 and likely never will, given that many deaths with other causes have been recorded as Covid deaths. The formal CDC designation is ‘Deaths with confirmed or presumed COVID-19, coded to ICD–10 code U07.1’, not deaths caused by Covid-19.

As of 18 December, provisional data suggest that 2,800, 974 million people had died in the USA in 2020, and about 10% of those deaths were ‘Covid-related’. This can be compared to the confirmed figures for 2018, when 2,839,205 people died.

It is now well established that the absence of diagnoses of and treatments for a range of conditions and diseases has led to additional non-Covid deaths, although it remains to be calculated whether these will outnumber the number of deaths ‘with confirmed or presumed COVID-19’, or even ‘true’ Covid deaths, caused by the disease or the body’s response to it. Still, the total number of deaths will not have risen between 2018 and 2020, despite the ‘daily 911s’.

The viewpoint authors conclude that ‘The failure of the public and its leaders to take adequate steps to prevent viral transmission has made the nation more vulnerable, allowing COVID-19 to become the leading cause of death in the United States, particularly among those aged 35 years or older. Much of this escalation was preventable, as is true for many deaths to come.’ This is inaccurate and hyperbolic. The finger-pointing is unhelpful and unaccompanied by any recommendation for ameliorating the dire situation it highlights, but fails to support with data.

It is perfectly clear that Covid is a serious threat to public health, a mild to moderate threat to the health of those aged between 15 and 84, and a severe threat to those aged 85 or older. Public health professionals such as the authors of the JAMA ‘viewpoint’ have rarely articulated the true nature of the threat, preferring to make us all responsible and anxious. The public at large, and greater numbers of those aged under 45, have not acted irresponsibly and ‘made the nation more vulnerable’. They are the nation and most have calculated the level of threat the virus poses to them, to their children, to their parents and grandparents, and are acting accordingly. However shrill some scientists may be, ‘the science’ does not support local and national governments imposing draconian restrictions that pose a greater threat than a novel coronavirus to the health and wellbeing of society over this year and the decade to come.

Yesterday, 3 December, was International Day of People with Disabilities. On 14 October 1992, the United Nations General Assembly passed a resolution inviting all member states to ‘intensify their efforts aimed at sustained effective action with a view to improving the situation of persons with disabilities’, and to that end proclaimed ‘3 December as the International Day of Disabled Persons’, also called the International Day of Persons with Disabilities. If the branding of the day has been inconsistent, that is hardly the reason that the day – indeed a week-long program of events – passed unnoticed by the vast majority of people with disabilities, and their families. For them, every day is ‘Day of People with Disabilities’ and they don’t really have the time to parse verbose themes like ‘Building back better: towards an inclusive, accessible and sustainable post COVID-19 world by, for and with persons with disabilities’.

Among the events staged by UNESCO was the launch of a new publication, Accessible Digital Documentary Heritage. According to its promotional materials, this publication ‘draws upon key features of the 2006 United Nations Convention on the Rights of Persons with Disabilities and the 2015 UNESCO Recommendation Concerning the Preservation of, and Access to, Documentary Heritage Including in Digital Form. This is in promoting and facilitating maximum inclusive access to, and use of, documentary heritage. The means to this is by empowering memory institutions to provide equitable person-to-person access services to original documents’.

I confess, as someone who lives with disability and has also produced digital cultural heritage objects, I have next to no idea what this means. That is not a great start, as I am apparently among the target group for the publication, which ‘include librarians, archivists, museums workers, curators, conservators, IT specialists involved in the digitization of documents, relevant professional bodies such as associations working with persons with disabilities, and other stakeholders interested in disability and accessibility aspects.’

It seems counter-productive as well as counter-intuitive to explain that ‘websites are often complex and cumbersome to navigate, making them inaccessible for users with cognitive or learning disabilities’, but to write your guidelines for remedying that situation in jargon so dense that it renders them unreadable. Fewer lengthy quotations from WHO, UNESCO and other official sources would help.

Perhaps it doesn’t matter that the booklet is completely inaccessible to people with cognitive and intellectual disabilities. After all, they are conceived as passive recipients of digital cultural heritage rather than active producers of it. Furthermore, the examples explored in the booklet reveal that its main concern is producing suitably ‘accessible’ metadata – descriptions for images, subtitle and signing for videos, etc. – for web content that assist those with hearing and visual impairments. The goal is important and worthwhile, but it is inaccurate to suggest that the guidelines are useful to those with other forms of disability. Which, in turn, is the problem with lumping all forms of disability into a single category, or a day, even if it lasts a week.

As the wearying year of Covid-19 grinds on, the determination by the UK government last spring to protect the NHS from demanding patients has raised the death toll considerably. Data on those who have missed essential treatments and therapies is patchy but anecdote abounds. We are all now more familiar with how excess deaths are tallied, and a recent report by the King’s Fund sets this out clearly, contextualizing Covid deaths.

Attention has turned recently to the dearth of diagnosis that has been part of the global health crisis. It is impossible to identify a huge range of conditions over even the best broadband connection, from ear infections to cancers. In the USA, diagnosis of the six most common cancers dropped by 46% between March and August, the direct result of screenings dropping by 90%. It has been estimated that 25 million GP appointments and 19 million NHS dental appointments were missed in the UK between March and November, including a million breast cancer screenings.

Failure to diagnose cancers may result in quick deterioration in health and premature death. Failure to diagnose chronic conditions will result in missed opportunities for treatment and recovery. In the case of Autism Spectrum Disorder, however, the NHS was failing to diagnose and treat patients long before the advent of Covid-19. There is no reason for this to continue. The latest research into the genetic basis for autism offers new opportunities for risk analysis and simple screening, if adopted, would allow rapid identification of children “on the spectrum”.

Delays in diagnosis have always been followed by failure to provide necessary treatments and therapies. Before Covid, two-thirds of those with an autism diagnosis were not receiving adequate services or care in the UK. This is not a polemical point: it was the conclusion of the All Party Parliamentary Group on Autism, reflecting on the first decade since groundbreaking legislation was passed in the UK. This was a marked improvement on the situation before 2009, which was still more appalling.

Autism Spectrum Disorder (ASD), a neuro-developmental condition, affects up to 2% of children born today throughout the world and it presents a range of challenges to families. Besides the diagnostic criteria for ASD which include (A) “persistent deficits in social communication and social interaction across multiple contexts”; and (B) “restricted, repetitive patterns of behaviour, interests, or activities”, autistic people manifest a series of co-occurring conditions. These include Motor abnormalities (79%), gastrointestinal problems (up to 70%), epilepsy (up to 30%), intellectual disability (45%), and sleep disorders (50–80%). Being autistic is challenging, and caring for an autistic relative is draining.

Left Stranded , a report published in September by the UK’s National Autistic Society, highlighted several areas in which autistic families have suffered more than others during our plague year. This is not whining or special pleading. It simply and honestly addresses the fact that autistic individuals and families rely far more on the help of others, often on a daily basis. Autistic adults who live independently may rely on the help of others to leave the house, to go shopping, to bathe and dress themselves. Those who live in residential care have that help, but face different problems. We are all now awfully familiar with the crises residential care homes have faced in 2020. The lives of autistic individuals are given focus and meaning by routine and core relationships. The removal of these structures leads to distress and anxiety. Although autism is not a mental health condition, 85% of those who responded to the Left Stranded survey reported heightened anxiety or depression.

When services are curtailed and when physical proximity is forbidden then essential therapies cannot be accessed. Many autistic individuals have low muscle tone, hypersenstivity or hyposensivity, meaning they are more or less sensitive to physical stimuli. The may feel lost in space, unable to orient themselves or move. Or they may need to move, to spin, to stimulate themselves. Occupational therapy and physiotherapy are essential to may with autism, and they rely on physical proximity and manipulation, close person-to-person contact. Physical therapies cannot be delivered by ‘telehealth’.

Speech and language therapy is also essential to many autistic individuals, but services offered by speech and language pathologists have similarly been curtailed. While many of us find it difficult to understand muffled or inaudible speech through face masks and shields, those with speech and language processing difficulties have always found it next to impossible to understand and interact with others, still less when they are wearing masks.

Left Stranded was delivered to the UK finance minister, Chancellor of the Exchequer Rishi Sunak. It appears to have been lost in his junk folder. As Caroline Stevens, Chief Executive of the National Autistic Society said of Sunak’s November 25th ‘Spending Review’, the UK Government ‘again missed the opportunity to commit the essential funding’ needed by autistic families.

“It’s not yet clear how what has been announced today will be spent, but the Government must invest in the support and understanding autistic people desperately need. Autistic children, adults and their families have been waiting years for funding for the diagnosis, education and social care services they need. This has never been clearer than during the coronavirus crisis. With the Government set to publish a new all-age autism strategy in the coming months, it’s vital the funding for these services is in place so autistic people and their families aren’t left stranded again.”

In October 2019, at a time when she was surging in the competition to become the Democratic nominee for president, Elizabeth Warren took a question from a nine-year-old child. The child, who was attending a LGBTQ ‘town hall’ event sponsored by CNN, was concerned about feeling safer at school. Warren was kind and supportive and her comments were received well by the audience at which it was directed. For a broader audience it included a swipe at Betsy DeVos, Donald J. Trump’s Secretary of Education.

Several months later, as she was sinking in the polls, Warren returned to this encounter. At the end of January 2020, asked at another town hall about the dearth of LGBTQ history in public education, she pledged to a crowd in Iowa that as president,

“I’m going to have a secretary of education that this young trans person interviews on my behalf, and only if this person believes that our secretary or secretary of education nominee is absolutely committed to creating a welcoming environment, a safe environment, and a full educational curriculum for everyone will that person actually be advanced to be secretary of education.”

No-one would question Warren’s devotion to inclusivity. She was very well informed about the issues and will have known before making her pledge that the integration of minority histories into public school curricula in the USA is very well advanced. At university level, one would be hard pressed to find a history course that is not devoted to a minority or oppressed population. Many, however, were wise to question the wisdom of offering a veto to a child, aged nine, on a cabinet-level appointment.

For many centrist Democrats, and all Republicans, Warren’s willingness to double down on the promise showed weakness, her pandering to an interest group that was vocal and disproportionately influential in the Democratic primary process. She was parroting the views of the Human Rights Campaign, a large and influential LGBTQ lobbying and advocacy group.

In marked contrast, for many voters Andrew Yang’s persistent support for autism intervention showed strength and resolve. It felt genuine to voters of both parties, inspired by his own experience as the parent of an autistic son. It resonated with every parent like him, worried about a child’s future and how he or she would be treated not just at school (although certainly there, where bullying is omnipresent), but afterwards.

By the most authoritative and sympathetic estimation, advanced by UCLA’s William’s Institute, 0.7% of the US population identifies as trans, including 150,000 youths aged between 13 and 17. As they enter the workforce, laws that protect their rights are essential. Transgender discrimination in the workplace is an important concern, but the matter of autism and employment is of a different order of magnitude. By some estimates, nine in ten autistic adults in the USA are unemployed or underemployed. Those in paid work tend to be paid very poorly. The problem is acute and it is very quickly becoming more substantial. According to the US Centers for Disease Control and Prevention (CDC), in 2014, 1.68% of children born in 2006 had been diagnosed as on the autism spectrum. This is 1 in 59 births, rising from 1 in 150 for children born in 1992. Emerging data suggest the number is rising still, and will soon reach 2%, or 1 in 50 births across all fifty states.

According to the American Psychiatric Association, gender dysphoria is a psychiatric condition that ‘involves a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify’. There may be a link between autism and gender dysphoria. According to Eric Butter, a professor of pediatric psychology and director at Nationwide Children’s Hospital, writing for the autism advocacy group Autism Speaks,

“Some studies have found [that transgender individuals] have a higher rate of autism diagnosis, with estimates ranging from 6 to 13 percent. Other studies have found people with autism likewise have a higher rate of gender dysphoria or gender variance. They are also often dealing with other commonly co-occurring mental and physical health issues. Given this observed higher rate of gender variance among children with ASD [Autism Spectrum Disorder], it is important that evaluations for autism routinely assess for gender variance and that clinical evaluations of youth referred for gender variance also screen for autism.”

Autism is a not a psychiatric condition, it is a neuro-developmental disorder that results in impaired communication, social interaction and a range of restricted, repetitive behaviours. Awareness that there may be a higher rate of autism in the transgender community suggests further study is warranted, but autism and gender dysphoria are separate issues and should not be conflated. Many children diagnosed with autism lack the ability to speak or communicate effectively about any matter, including gender variance.

Parents of autistic children quickly become single-issue voters. When Yang withdrew from the race, many looked again at Warren, who once taught children with speech and language difficulties. She was committed intellectually to the rights of those with disabilities. Bernie Sanders, similarly, was committed to providing additional federal funding to support disabled students in schools. Amy Klobuchar could claim a distinguished legislative record on autism. She was Democratic sponsor of the 2014 ABLE act, six years after, as a new senator, she had co-sponsored the Americans with Disabilities Amendment Act (ADAAA) 2008. In 2017, she co-sponsored ‘Kevin and Avonte’s Law’, named after two autistic boys who died after wandering. The law provided funding for technology and training for the carers of autistic and vulnerable children and adults. Klobuchar speaks regularly about disability and mental health, recounting stories of her father’s alcoholism and her infant daughter’s reliance on a feeding tube. However, she has been criticized by disability advocates for not consulting adequately with their community when crafting her ideas and policies.

Several of these ex-candidates will be hoping for a role in Joe Biden’s administration. Biden can claim to have a track record on autism. In 2014, the Obama administration passed the Autism Cares Act, which reauthorized and expanded the provisions of the Combating Autism Act of 2006. Under the Affordable Care Act, Obamacare, autism screening was mandated for all children aged 18 to 24 months during ‘well visits’ to a doctor. Additionally, health insurance companies were required to pay for autism services for all children with a diagnosis, which the CDC has estimated costs between $17,000 and $21,000 per year per child. In the same year, Achieving a Better Life Experience (ABLE) 2014 was enacted, allowing for the creation of tax-free savings accounts for the disabled. A huge range of goods and services can be purchased using an ABLE account, including regular living expenses using a debit card that can be linked to the account.

Trump, on the other hand, notoriously mocked a disabled reporter at a campaign rally in 2015. He has regularly advanced the notion that vaccination is linked to autism, including as a presidential candidate, although he stopped short of proposing a commission to investigate the matter once he was elected. Yet, his tax law of 2017 was beneficial for parents of disabled children who were putting away money for a child’s higher education, for example in a tax-advantaged college saving’s account (a ‘529’ account). Transfers from a regular 529 to an ABLE account are now authorized, up to $15,000 annually, a small source of consolation to parents coming to the realization that their child will not be able to attend college. Additionally, up to $10,000 can be spent annually from a regular 529 account on private school tuition, including special education, rather than saved for college.

In October 2019, Trump signed the Autism CARES Act 2019, a further re-authorization of the 2006 and 2014 laws, that commited $1.8 billion to fund research and education activities at government agencies. One of the bill’s sponsors, Senator Chris Smith of New Jersey, a Republican, announced that the new law “will fund critical biomedical autism research as well as the development of best practices to enhance the lives of persons with autism”.

The CNN town hall at which Elizabeth Warren made her offer to a child was later the scene of protests by those who wished to highlight the plight of black transgender women. The candidate on stage at that time, Pete Buttigieg, a white gay man, responded sympathetically, that he did wish to “acknowledge what these demonstrators are speaking about, which is the epidemic of violence against black trans women”. Buttigieg was borrowing the language of the Human Rights Campaign, to signal his fellowship. The growth of autism in the USA might more accurately be described as an epidemic. A substantial and rapidly growing demographic, the parents and families of autistic children, and young people with autism voting for the first time, may eventually have a great impact upon American politics. Autism transcends party politics, and Democrats cannot count on the votes of the autism community as they can those of the LGBT community.

Photographs of Boris Johnson out hiking with his son hanging loosely from his ample frame caused the expected Twitter storm towards the end of August. Concern for the baby’s welfare was, for many, no more than a useful entry point for criticism of the father. However, for Wilf Johnson’s health and development, Boris’ skills with a papoose may prove less consequential than the Prime Minister’s age and that of Wilf’s mother, and the fact that Wilf is a little boy. These factors increase the odds significantly that Wilf may one day be diagnosed as autistic.

Boris, at the age of 55, and Carrie Symonds, aged 31, became parents to a baby boy at the end of April, apparently somewhat earlier than expected. Very few details were released to the public other than his name. The birth took place during the height of the first wave of Covid-19 in London, shortly after Boris contracted the disease and spent some time in an ICU bed. Most of us will not have wondered much about Wilf and his health until or since the family photos were released. However, I, like many parents of autistic children, wonder a lot about the development of the children of public figures. I wonder what it would be like if Wilf were autistic and the Prime Minister chose to address the challenges of raising an autistic child publicly. More than raising awareness, important as that would be, I wonder how the lives of countless families might be transformed if a PM understood autism and made its diagnosis and care a priority.

Prime Ministers have been highly protective of their children, and the public may have forgotten what they learned from David and Samantha Cameron about cerebral palsy (CP) and epilepsy or from Gordon and Sarah Brown about cystic fibrosis (CF). Both conditions are very serious and quite rare: CP affects between 2.3 and 3.6 children for every 1000 born, and CF around 1 in every 2000-3500 infants. Autism Spectrum Disorder (ASD), a neurodevelopmental condition, is far more prevalent. It affects up to 2% of children born today throughout the world and it presents a range of challenges to families. Boys are far more likely to be autistic than girls, and premature children are also at higher risk.

Besides the diagnostic criteria for ASD, which include (A) “persistent deficits in social communication and social interaction across multiple contexts”; and (B) “restricted, repetitive patterns of behaviour, interests, or activities”, autistic children manifest a series of co-occurring conditions. These include “Motor abnormalities (79%), gastrointestinal problems (up to 70%), epilepsy (up to 30%), intellectual disability (45%), and sleep disorders (50–80%)”.

A 2019 study of “Genetic Causes and Modifiers of Autism Spectrum Disorder” observes that “ASD is now understood to be a disease of complex interaction between genetics and the environment, with heritability estimates ranging from 40 to 80%”. As a condition with a genetic basis, there is a strong correlation between parental “risk factors” and prevalence of autism, although at this time causation remains unclear.

According to research published in the journal Molecular Psychiatry , the parents least likely to have an autistic child are in their twenties or thirties and relatively close in age. “In a population-based cohort study from five countries (Denmark, Israel, Norway, Sweden and Western Australia) comprising 5,766,794 children born 1985–2004 … the relative risk of ASD was estimated” to be far higher for fathers aged 50 and older, who produced 1.66 autistic children for ever one fathered by men in their twenties.

The highest risk is associated with increased age of both parents, especially where there is a significant age difference between mother and father. Boris is 24 years older than Carrie. Their pregnancy, therefore, presents a higher risk of producing a child with an ASD, although lower than if Carrie were also aged 40 or older. The risk remains small, no more than 2%. But the greatest increased risk for children born to older couples or those with greater age differences is not level 1 ASD, formerly known as Asperger’s, but of level 3 autism with associated intellectual disability.

Children with a level 3 diagnosis require early and regular interventions, typically including thousands of hours of speech and occupational therapy over many years. With a sufficient level of input begun below the age of two, some may advance to the level of “neurotypical” peers in achieving basic milestones. However, in the UK this will not be easily achieved. Most autistic children in the UK are flagged by schools, when by definition they are already too old for “early intervention” therapies.

Securing a diagnosis of ASD for a child under school age requires prompt action by alert, concerned parents. The “Modified Checklist for Austism in Toddlers” M-CHAT is an excellent online tool for parents concerned about a toddler’s development. For children under five, GPs act as gatekeepers. A good GP will trust parents who come armed with an M-CHAT and a list of concerns, and will observe the child closely. However, few GPs are expert in recognizing neurodevelopmental delays in very young children. If a referral to a consultant is made, the chance it will be rejected is very high. If an assessment is scheduled, it will take many months for the child to move up a waiting list. For most it will take longer than a year. If a diagnosis is secured, then the grueling process of identifying and securing services and therapies will start. Each day waiting is a day lost.

Screening and “early intervention” therapies for children aged two and three, although they are simple and cost effective, are almost unknown in the UK. They have become the norm in the USA, where the American Academy of Pediatrics recommends autism screening during routine doctor visits for toddlers aged 18 and 24 months. Effective autism screening is also undertaken in an increasing number of European countries and worldwide. The M-CHAT, a simple list of twenty questions, is among them and it has even been translated into Arabic for use by clinicians in Saudi Arabia. However, it is not used by GPs the UK, although the original CHAT was developed in Britain by Simon Baron Cohen.

The odds that Wilf Johnson will be “neurotypical” are very high indeed and are not affected by how tightly or loosely Boris straps him into a papoose. Of the 600,000-700,000 children born in the UK each year, around 10,000-12,000 will be autistic. Many will have had better odds than Wilf in the parental lottery. All should receive the earliest diagnosis and the best treatment possible.