What the unemployment figures are like now, during the pandemic, for autistic workers?
There’s been a lot of controversy about Myka Stauffer and her husband’s decision to “re-home” their adopted autistic child. Today in the Washington Post Katherine Sanford did a version of the traditional “walk a mile in their shoes“ argument in their defense. To her credit, Sanford mostly blamed the lack of social supports for parents of special needs kids, although she also managed to get in a few whines about how hard it is to deal with a non-verbal 13-year-old in diapers.
Well, guess what? I’ve already walked the mile. Been there. Done that. Wiped the feces off the wall. Bandaged the bites and kicks. And I say it’s time for parents who either gave birth to or adopted a special needs kid to stop thinking about how hard it is for them and start thinking about how hard it is for their kid.
These kids have minds—even if their thoughts are concealed by their lack of speech. They have hearts—even if you can’t recognize their feelings. They hear what you say to them and to others, and react to it—even if you don’t understand their reactions.
Stauffer’s son has already been rejected by one set of parents in China. And now he’s been rejected by another set in the U.S. So what do his mind and heart tell him about this? That he’s worthless. That he’s so bad that adults just can’t stand to keep him around. It’s not ok to do that to a kid. Any kid. Autistic or not.
The last week has been hard for all of us, but it’s been hard in a particularly weird way for my family. We have been getting an “up close and personal” glance at the huge divide in this country between Trump supporters and the resistance.
My husband and I are your classic old white liberals. We have a “Black Lives Matter” sign in front of the house, we’ve been marching despite our fear of Covid-19, and we’ve been signing petitions and writing letters. It’s not much, but we do what we can in support of our African-American brothers and sisters who are still hurting so deeply.
Our autistic daughter, who generally shares our political views, recently moved in with her boyfriend. He has a house in a tiny rural village, mostly occupied by members of his extended family. And that family is about as far from liberal as you can get. They all get their news not even from Fox News, but from Facebook. This led them to conclude last week that a caravan of “black looters” was on its way to their village to pillage and plunder. Beyond the fact that there is no black community nearby to provide the looters, it doesn’t seem to have occurred to them that they have nothing worth looting. But they imagine that people who are racially and ethnically not like them are always on the verge of doing something awful.
As my husband and I worry about police brutality and attacks on civil liberties, our daughter is listening to hateful remarks about African Americans, and about how President Trump needs to declare martial law and use the army to restore law and order.
In the end, I suppose it is useful for us to be aware of such a different world view. But in this moment it sure is weird and disorienting.
Powerful words from Carly Fulgham
Friday night, March 27th, I told my husband, “If I get COVID-19 and have to be hospitalized, don’t tell them I have Autism.” The next morning I woke up angry that I had to say that so close to the 30th anniversary of the Americans with Disabilities Act. March 12th marked thirty years since eight-year-old Jennifer Keelan abandoned her wheelchair to crawl up the steps of the US Capitol building to prove that people with disabilities deserved an equal chance in life. Thirty years later, it’s still an acceptable option to consider us less.
Doctors in Italy are “having to make hard choices” about who is worthy to get treatment, with age and disability being part of the discussion. I’ve heard these tough choices are being debated from Washington state to Alabama as well. When this ethical conundrum comes to my town, I hope that our medical leaders remember that in many cases, disability is just a label, and should be used as a criteria no more than race, religion or gender.
In addition to my autism, I have asthma that is bad enough that I have a greater chance of needing a ventilator. If I am so sick that I’m in the hospital, how are they going to know that besides the “Autism” written on my medical chart, I’m a wife and a mother to a two-year old? A Vice President at one of the biggest companies in America where I’ve just won a Global Diversity & Inclusion Award? A volunteer member of the Board of Directors of Autism Society of California, The Art of Autism, and Autism Society of America? The volunteer President of Autism Society of Ventura County where I’ve increased our program offerings more than tenfold in four years? How will they know all this when I’m alone and too sick to explain why my life matters?
Do you think I’m different from other people with disabilities? That my accomplishments make me the exception and not the rule? That my family will care about my survival more or less than another’s? When we’re desperate for oxygen, we all look the same. The only differences are the labels on our chart, like our disability and our age. We expect our medical professionals will not discriminate based on race, religion, language, age, or disability during normal times. We cannot abandon the basic human right to live now, no matter what label we wear. I’ve still got a lot more to give to this world.
I’m not done yet.
Many students—not just autistic ones—believe that they have been unfairly suspended or expelled from school. Many students—not just autistic ones—do not fully understand why they were suspended or expelled (sometimes it is hard for adults to figure that out either). Suspensions are very often used as a punishment in U.S. schools not only for serious offences, but also for all kinds of minor infractions of the rules. Crying in school may lead to unofficial suspensions, in which parents are told to pick up their children and take them home. But students may be officially suspended for not meeting the school dress code (this includes even very young children, whose parents pick out their clothes), for having the “wrong” hairstyle, or even for carrying a backpack with the “wrong” picture on it. Most school codes of student conduct still include vague terms for misbehavior, such “insubordination” or “willful defiance,” which individual teachers can interpret subjectively. In recent years, some major school districts have removed this language, but in many other places students can still be suspended for eye-rolling, walking away from a teacher without being dismissed, failing to complete homework, or even tapping their feet on the floor.
Sometimes just needing to use the restroom at an inconvenient time for the teacher or other school staff member will be enough. In December 2018, an 11-year-old autistic African-American child asked to use the bathroom in his elementary school. The principal of the school, who was escorting him and another student back to their special education classroom, refused to let him go–even though access to the restroom at any time was the rule for Special Education students. The child couldn’t get around the principal to reach the nearby bathroom, so he went out the back door of the school to find another restroom. The principal then ordered school staff to lock all the doors and not let the student back in. He wasn’t trying to run away—in fact, he spent 15 minutes circling the school, as teachers ignored his appeals for help, walking past him outside without speaking, and even pulling down the window blinds in his face. Finally, another student took pity and opened a door for him. The school sent his parents an incident report, but they failed to mention the dangerous and illegal lock-out—and the child received a two-day suspension for leaving the school building without permission. Only after the school’s security tapes were reviewed did the true story come out. The principal was then placed on paid administrative leave.
Suspension and expulsion are over-used forms of discipline in American schools, for students of all neurotypes. But autistic children face special challenges. Sensory, emotional, or other stressors can drive them into meltdowns or shutdowns, during which their “fight or flight” instincts take control, sometimes leading to violent reactions. Meltdowns /shutdowns are clearly “manifestations” of autism, and so theoretically schools should respond to them with behavioral interventions. Yet in practice, many autistic students face suspension, expulsion, and even arrest for what they do during these episodes. Students cannot control their own actions during meltdowns, so is it reasonable or fair for them to be punished in this way?
Moreover, many teachers don’t acknowledge their own role in triggering these problems. In New Mexico, for example, a second-grader had a meltdown because his teacher yelled directly into his face, and then took away his Ipad, which was a very important comfort object for him. She caused the meltdown, during which she was struck in the nose, causing a bruise. Yet not only was the child—who happens to be black—suspended from school for having a meltdown, but his teacher actually pressed battery charges against an 8-year-old.
In Florida, an autistic fourth-grader who had just gone through a long, stressful day of testing, was bothered by the noise when his teacher put on a movie (presumably as a reward for the other students.) Seraph put on headphones and sat at a computer to distract himself from the noise, but he could still hear the movie. So he started tapping computer keys loudly to drown it out. That’s where the trouble began. The teacher called in the dean, the assistant principal, and the school resource officer to remove him from his classroom. He was willing to leave, but, looking for a quiet place to recover from the noise, he entered the school media room. At this point, another teacher began reading a book to him—yet more noise. Seraph, with his hands covering his ears, went over to the teacher and knocked at the book, using his elbow. (The teacher was untouched). The school resource officer then tackled him to the ground with so much force that Seraph ended up with carpet burns on his face. He was suspended for several days—not because anyone was injured or even threatened, but simply because he was autistic and overstressed by noise.
It is not unusual for autistic students to be get in trouble for leaving their classroom, or even their school without permission. What is unusual is for schools to acknowledge what autistic students remember–that they often fled to avoid bullying:
I received three suspensions from my school during my time there, two for leaving the room to seek sanctuary in the library when the entire class (teachers included) united in mocking me, and one for deliberate non attendance over a period of days (truanting).
Autistic students are disproportionately bullied at school. And within a few years of being in school, they realize that the advice they are given—”speak to a member of the school staff”—is almost always ineffective. School staff rarely stop the bullying. They may fail to see what happened (and bullies are very adept at flying under the radar). They may believe the bullies rather than the victim—because a highly verbal neurotypical bully can be more convincing than an autistic victim, or because there may be multiple bullies whose united testimony outweighs that of the victim. (This is what happened to my own daughter.) School staffers may simply not care.
one time a boy way bigger than me punched me in the face and made my nose bleed, and a teacher caught me inside trying to clean myself up, and I got yelled at for being inside during recess even though I was dripping with blood; nothing was done about the boy who hit me . . .
People beat me up and they’d go free and I’d be in detention.
Teachers may even dislike the autistic student and want him or her to suffer. One autistic student listed reasons why she hated school:
Being bullied and being told it was my fault.
Being my teacher’s punching bag.
The only solutions for these students are either to endure the suffering (the trauma this causes was described in an earlier post), to run away (and thus be suspended), or to retaliate—and retaliation often ends in their being suspended or expelled as well. Here is “Aristophanes’s” description of his experience at school:
Attempting to avoid a fight, getting flat out sucker punched instead, and going to the principal who gave me as much detention as the aggressor, reasoning ‘you’re going to be an adult soon, you need to learn to solve your own problems, that’s the lesson here.’
Going back literally a week later, getting punched again, and retaliating by stomping my heel on the kid’s ankle, fracturing his tibia and earning me a suspension that go around.
Other autistic students remember fighting with their bullies, and then being punished for it—while the bullies got off scot free:
Once [a privileged person] tried to stab me and he got off without a punishment simply because [his] family was rich. I got a suspension and was threatened with expulsion because i kicked him in the stomach and dropped him to the ground.
An increasing number of parents are filing lawsuits against school districts that allow things like this to happen. For example, a Staten Island teenager was suspended for three days because he allegedly pushed to the ground bullies who had been physically assaulting him for years—including breaking his arm at one point. His parents sued the school district, “claiming he was wrongfully punished for something his school should’ve done — and that’s stop his bullying.” A lawsuit pending in Cinncinnati, Ohio, charges a local school district with denying a student’s right to FAPE, both by refusing to recognize his disabilities and provide appropriate accommodations, and by failing to address the constant bullying he was subjected to. The suit alleges that the school district suspended this young man multiple times, when he fought back or even just shouted at the students bullying him. Even when he didn’t fight back, the school sometimes disciplined him. In one of the incidents reported in the lawsuit, a bully spit on him, and called him names on the school bus. It was the victim, not the bully, who was suspended for this incident.
Perhaps the most significant problem with the use of suspension and expulsion as forms of discipline is that many autistic students hate school, and therefore prefer being removed from it. This is the attitude of “Agent Smirnoff”:
I thoroughly enjoyed my time in suspension, as it granted me peace from the incessant bullying and allowed me to play on my computer all day.
“deog” felt the same was about expulsion:
The highschool years are very difficult. . . . My misery and depression was profound. I got expelled by my sophmore year. i was ditching certain classes almost every single day… I was so happy when I got expelled and I have no regrets about that because I was just done . . .
It is fairly common for autistic and other students to misbehave on purpose in order to get some relief from their sufferings at school. Sebastian, a student in New Mexico “relished being sent to in-school suspension, which he came to see as a haven from the stress of the classroom. Once, his mom says, he randomly punched a classmate in the parking lot in an effort to get sent back to the peace and quiet of in-school suspension.”
When I was in grade school, I would purposely act up in order TO GET suspended. Sure my mom wouldn’t let me watch TV and stuff and would sometimes make me work on store bought workbooks, but I didn’t care. I just didn’t want to be at school. Suspension was a reward to me. The school was starting to catch on that I was acting up on purpose and tried something called an “in school suspension”. I was in a classroom with a “babysitter” and with the exception of the “babysitter”, I was all alone. I was allowed to draw and color all day long. The classroom I was in was even quieter than my own house. I perfered quiet. Some punishment.
The problem with students seeking out suspension and even expulsion for relief from stress is that they don’t realize the implications for their future. Having a “record” is not helpful when applying to college or looking for a job, but many autistic students find school so painful that they don’t care.
Instead of suspending autistic students at such high rates, school districts should be looking for ways to make school more tolerable for them, ways to prevent them from having meltdowns, ways to seriously address the problem of bullying.
 Morgan Craven et al., “Suspended Childhood: An Analysis of Exclusionary Discipline of Texas’ Pre-K and Elementary School Students, Updated with 2015-16 Data,” for the Texas Appleseed organization, November, 2015; updated March, 2017: http://stories.texasappleseed.org/suspended-childhood-updated.
 Nina Agrawal, “California expands ban on ‘willful defiance’ suspensions in schools,” Los Angeles Times September 10, 2019: https://www.latimes.com/california/story/2019-09-10/school-suspension-willful-defiance-california.
 Jessica Oh, “Child with autism locked out of school,” report on Kiro 7 television in Seattle, January 23, 2019: https://www.kiro7.com/news/local/child-with-autism-locked-out-of-school/908564250/. This incident was widely reported elsewhere.
 “Teacher files charges against 8-year-old student who hit her”, report on KQRE TV, April 14, 2018: https://abc13.com/education/teacher-files-charges-against-8-year-old-student-who-hit-her/3344462/. The incident was also widely reported.
 David M. Perry, “America Keeps Criminalizing Autistic Children,” Pacific Standard June 12, 2017: https://psmag.com/education/america-keeps-criminalizing-autistic-children.
 Agent Smirnoff, in the “Is Suspension Really a Punishment?” discussion on the Wrong Planet website: https://wrongplanet.net/forums/viewtopic.php?t=194004.
 dragoncat, in the “Things You Hated About School” discussion on the Autism Forums website (October 28, 2017): https://www.autismforums.com/threads/things-you-hated-about-school.22361/#post-443119. It is worth noting that this topic elicited four pages of responses.
 tlc, in the “Things You Hated About School” discussion on the Autism Forums website (March 30, 2018): https://www.autismforums.com/threads/things-you-hated-about-school.22361/#post-443119.
 SchrodingersMeerkat, in the “Things You Hated About School” discussion on the Autism Forums website (October 27, 2017): https://www.autismforums.com/threads/things-you-hated-about-school.22361/#post-443119.
 Aristophanes, in the “Why School Sucked” discussion on the Wrong Planet website: https://wrongplanet.net/forums/viewtopic.php?f=3&t=357585&start=60.
 The Musings of the Lost, in the “Why School Sucked” discussion on the Wrong Planet website: https://wrongplanet.net/forums/viewtopic.php?f=3&t=357585&start=60.
 Elizabeth Rosner and Chris Perez, “Autistic student suspended for standing up to bullies, $5M suit claims,” New York Post August 17, 2018: https://nypost.com/2018/08/17/autistic-student-suspended-for-standing-up-to-bullies-5m-suit-claims/.
 Max Londberg, “Suit: Winton Woods Officials Allowed Bullying of Student with ‘Significant Autism’ for Years,” Cincinnati Enquirer August 19, 2019: https://www.cincinnati.com/story/news/2019/08/19/suit-winton-woods-officials-allowed-bullying-student-autism/2054763001/.
 Agent Smirnoff, in the “Is Suspension Really a Punishment?” discussion on the Wrong Planet website: https://wrongplanet.net/forums/viewtopic.php?t=194004.
 deog, in the “I’m So Done!!!! discussion on the Autism Forums website: https://www.autismforums.com/threads/im-so-done.27361/#post-552380.
 Ed Williams, “Criminalizing Disability,” Searchlight New Mexico, May 7, 2019:
 MagicMeerkat, in the “Is Suspension Really a Punishment?” discussion on the Wrong Planet website: https://wrongplanet.net/forums/viewtopic.php?t=194004.
The reality of school discipline is more complicated than the law would suggest. To begin with, students with disabilities, as a group, are much more likely to be suspended from school than students without disabilities. A 2018 report, “School Climate and Safety Report” published by the Department of Education’s Office for Civil Rights found that even though only 12% of all students in the U.S. have disabilities, 26% of those subject to out-of-school suspension and 24% of those expelled have disabilities. In other words, students with disabilities are being suspended and expelled at roughly twice the rate of other students. Students of color, especially African Americans, face even higher rates of disciplinary removal from school. Among students with identified disabilities, roughly 9% of whites and Hispanics were suspended in any given year, while 21% of Native Americans and 23% of black students were suspended.
If we look specifically at autistic students, we should remember, first of all, that there are still many autistic students who have not been formally diagnosed. Unless they happen to have another, recognized, disability, they are not protected under IDEA and may be suspended or expelled because of behavior that would be considered a “manifestation” of autism in a diagnosed student. Since girls and minority students are much less likely than white male students to be diagnosed with autism, they are also more likely to lack IDEA protections against excessive suspensions and expulsions.
Relatively little research has focused on children with an actual autism diagnosis, but a 2018 report from the Center for American Progress states that pre-school children diagnosed with autism are ten times more likely to be suspended or expelled than their “typically developing” peers. A 2017 research study analyzes data for older children in the state of Maryland, from 2004 to 2015. The authors found that about 3.3% of both white and African American students with autism were suspended during this period. White autistic students were much more likely that non-disabled white students to be suspended, while autistic African American students were less likely to be suspended than non-disabled African American students.
The fact that both groups of autistic students this study were suspended at the same rate suggests that both groups were treated equally. But bear in mind that African Americans are much less likely than whites to be diagnosed with autism and may instead be diagnosed with intellectual or emotional disabilities. In the same study, 10.5% of African American students with intellectual disability had been suspended at least once, compared to only 7.3% of white students with ID. If we assume that at least some of those diagnosed with ID also have autism, or have been misdiagnosed with ID instead of autism, then it looks like the rate of suspension for African American students with autism probably is higher than it is for whites. The authors provided no data comparing students with autism and students with “emotional disturbance,” but African-American children with autism are very frequently misdiagnosed with ED, and students with ED are the most likely of all disability groups to be suspended or expelled. It seems plausible, then, to assume that African Americans and members of other minority groups with autism are at higher risk of being removed from school than white students with autism.
There is also the question of how often autistic students are suspended. Sometimes schools suspend children “unofficially,” by saying they are having a “bad day” and would be better off at home. They call the parents to pick the child up, but do not register this event as a suspension. This allows the school to get around federal regulations that limit the number of suspensions that can be imposed on students with disabilities. As a result, suspensions from school can occur with stunning frequency. A report on television news in Washington state looked at statewide rates of suspension and expulsion for students with disabilities, with results similar to those described above. The main focus of the report, a young autistic man named Austin, was suspended for more than 100 days during his time in middle school (far, far beyond the 10 days a year allowed under IDEA and federal regulations). Another young autistic man in Washington state was officially suspended for 24 days, and unofficially for 45 days, for a total of 69 days out of the classroom during a single school year. While these are extreme cases, it is not at all unusual for schools to use unofficial removals to evade the limits set on suspensions by law.
Repeated removals from school obviously limit children’s educational opportunities, leading them to fall farther and farther behind other students academically. But beyond that, repeated suspensions and expulsion from school have devastating emotional effects on children. As Austin, the young man mentioned in the last paragraph, put it: “I felt like I was one of the worst kids that ever was because they were just constantly sending me home.”  Disciplinary removal may alienate children from schools which they see as simply not wanting them. And so, children repeatedly suspended and expelled are much more likely to drop out of school altogether. “As a teen, I was expelled from the entire county school system and my parents had to find a private school willing to take me. At sixteen, I dropped out of school altogether,” recalls one autistic adult.
Finally, repeated suspensions and expulsion promote entry into the “school-to-prison pipeline,” especially, but certainly not exclusively, for young African American males. School “resource officers” (i.e., armed police officers) often intervene in disturbances at school, all too often in inappropriate ways. They may end up handcuffing and even bringing to jail autistic students seen as “disruptive”—setting up a vicious cycle in which these students see authorities as the enemy and act out accordingly. In addition, many suspended and expelled students spend their days unsupervised at home or on the streets, where they may engage in a variety of criminal activities, eventually leading to arrest and imprisonment.
As research has repeatedly shown, disciplinary removal from school has no positive impact at all on student behavior. On the contrary, it is more likely to worsen that behavior. As a result, the official policy of many school districts is that suspension and expulsion should only be used when necessary to protect other students and staff, or when guns or drugs are involved. In practice, however, these disciplinary techniques are often used to “punish” students who skip classes, fail to complete their homework, or talk back to their teachers. As we’ll see in the next post, autistic students who receive these punishments often view them as senseless, and even malicious (a way for “mean teachers” to get back at them).
 Office of Civil Rights, Department of Education, “School Climate and Safety,” 2018 report based on the 2015-16 Civil Rights Data Collection: https://www2.ed.gov/about/offices/list/ocr/docs/school-climate-and-safety.pdf. The disparity begins in preschool: Cristina Novoa and Rasheed Malik, “Suspensions Are Not Support: The Disciplining of Preschoolers With Disabilities” (Report from the Center for American Progress, January17, 2018: https://www.americanprogress.org/issues/early-childhood/reports/2018/01/17/445041/suspensions-not-support/. See also [No author], “Washington special needs students disciplined more than twice as often as general education peers,” report on King5 television news: https://www.king5.com/article/news/local/washington-special-needs-students-disciplined-more-than-twice-as-often-as-general-education-peers/281-608161669.
 Nicholas Gage, et al., “National Analysis of the Disciplinary Exclusion of Black Students with and without Disabilities,” Journal of Child and Family Studies 28:7 (2019), 1754-64.
 Office of Special Education and Rehabilitative Services, “Racial and Ethnic Disparities in Special Education: A Multi-Year Disproportionality Analysis by State, Analysis Category, and Race/Ethnicity” (2016), pp. 23-24: https://www2.ed.gov/programs/osepidea/618-data/LEA-racial-ethnic-disparities-tables/index.html.
 Cristina Novoa and Rasheed Malik, “Suspensions Are Not Support: The Disciplining of Preschoolers With Disabilities” (Report from the Center for American Progress, January17, 2018: https://www.americanprogress.org/issues/early-childhood/reports/2018/01/17/445041/suspensions-not-support/.
 M. Krezmien, et al., “Suspension Rates of Students with Autism or Intellectual Disabilities in Maryland from 2004 to 2015,” Journal of Intellectual Disability 61:11 (November, 2017), 1011-1020
 M. Krezmien, et al., “Suspension Rates of Students with Autism or Intellectual Disabilities in Maryland from 2004 to 2015,” Journal of Intellectual Disability 61:11 (November, 2017), 1011-1020.
 Robert Tudisco, “Can the School Give my Child With an IEP ‘Unofficial” Suspensions?’”, on the Understood.org website: https://www.understood.org/en/school-learning/your-childs-rights/basics-about-childs-rights/can-the-school-give-my-child-with-an-iep-unofficial-suspensions; see also Cristina Novoa and Rasheed Malik, “Suspensions Are Not Support: The Disciplining of Preschoolers With Disabilities” (Report from the Center for American Progress, January17, 2018: https://www.americanprogress.org/issues/early-childhood/reports/2018/01/17/445041/suspensions-not-support/.
 Report from the Washington State ACLU, “Pushed out; kicked out: Stories from families with special education students in Washington”: https://www.aclu-wa.org/pages/pushed-out-kicked-out-stories-families-special-education-students-washington.
 [No author], “Washington special needs students disciplined more than twice as often as general education peers,” report on King5 television news: https://www.king5.com/article/news/local/washington-special-needs-students-disciplined-more-than-twice-as-often-as-general-education-peers/281-608161669.
 Amity Noltemeyer, Rose Marie Ward, and Caven Mcloughlin, “Relationship Between School Suspension and Student Outcomes: A Meta-Analysis,” School Psychology Review 44 (2015), 224-40; Susan Faircloth, “Factors Impacting the Graduation and Dropout Rates of American Indian Males with Disabilities,” in Susan Faircloth, Ivory Toldson, and Robert Lucio, eds., Decreasing Dropout Rates for Minority Male Youth with Disabilities from Culturally and Ethnically Diverse Backgrounds (Clemson, SC: National Dropout Prevention Center for Students with Disabilities, 2014), pp. 8-9.
 Max [formerly known as Sparrow Rose] Jones, No You Don’t: Essays from an Unstrange Mind (Self-published, 2013), p. 51
 Abigail Novak, “The association between experiences of exclusionary discipline and justice system contact: A systematic review,” Aggression and Violent Behavior 40 (2018), 73-82; Amity L. Noltemeyer, Rose Marie Ward, and Caven Mcloughlin, “Relationship Between School Suspension and Student Outcomes: A Meta-Analysis,” School Psychology Review 44: 2, (June, 2015): 224-24; A.E. Cuellar and S. Markowitz, “School Suspension and the School-to-Prison Pipeline,” International Review of Law and Economics 43 (2015), 98-106.
 Ambra Green, Deanna Maynard, and Sondra Stegenga, “Common misconceptions of suspension: Ideas and alternatives for school leaders,” Psychology in the Schools 55:4 (April, 2018), 419-28.
My apologies for all the legal stuff that follows. Understanding how suspension and expulsion can legally be imposed on autistic children requires understanding the complicated provisions concerning student discipline laid out in the Individuals with Disabilities Education Act (IDEA), as amended in 1997 and 2004.
In the United States, under the current, amended form of IDEA, not only are children with autism and other disabilities entitled to FAPE (a free, appropriate, public education, in the least restrictive environment possible), but school actions that might deny them FAPE by removing them from the classroom are subject to legal limitations. The school must be very careful about removing a child temporarily (suspension) or permanently (expulsion), if the child’s behavior is a “manifestation” of her or his disability—that is, the behavior is caused either by the disability itself, or by the school’s failure to carry out the child’s IEP plan. For example, if a child gets into trouble for not doing what the teacher says, and if it turns out that the child has an auditory processing disorder which makes it difficult or impossible to hear what the teacher is saying, and if the accommodations for auditory processing disorder written into her or his IEP have not been fully implemented, then the school cannot suspend or expel the child.
The school also cannot use removals from the classroom in ways that turns them into an unofficial “change of placement” to a more restrictive environment. If the school does want a change of placement, it is supposed to follow a formal review process, showing that the school has done all that it can to offer the student accommodations and teach him or her “better” behaviors, without success. But because these actions present a major obstacle to their child receiving FAPE, parents who know their child’s rights can and do appeal school decisions through the state education system and possibly in court.
Schools use both in-school suspensions, in which a child is removed from the classroom but remains in the building, and out-of-school suspensions, in which a child is normally sent home, to punish unwanted behaviors. According to federal regulations, a disabled child cannot be suspended in either setting for more than ten consecutive school days in response to a particular incident. If the school wants to suspend a child for a longer period of time, it must provide appropriate educational and additional IEP services, at the school or at home, so that the child can continue to receive an education. The school must also hold a “manifestation determination review” to decide whether the child’s unwanted behavior or behaviors is a “manifestation” of their disability. If they conclude that it is, additional efforts must be made to modify the child’s behavior. The school is required to review his or her Individualized Education Program (IEP) to ensure that it is being fully implemented, possibly conduct a first or a new Functional Behavior Analysis (FBA) to determine why the child is “misbehaving” in the first place, and then find ways to teach the student “better” behaviors, while keeping her or him in the classroom.
Even for students whose behavior is determined to be a “manifestation” of their disability, there are exceptions to the “ten day” rule. Under certain circumstances—involving guns, drugs, or serious violence against another person—a student may be removed from the school for up to 45 days, as long as educational services continue to be provided in an “interim alternative educational setting.” The law does not specify what this term refers to—it simply says that the child should continue to receive educational services while in this setting. Under some circumstances and in some places, children may be sent to special programs run by the school district, but located away from the school itself. Under other circumstances, children may be sent to juvenile detention centers, residential treatment centers, or even psychiatric hospitals. There are educational opportunities at these places, but they are—to say the least—extremely limited.
Even without guns or drugs or violence being involved, schools can legally suspend autistic students more than once a year, so long as educational services continue to be provided. But if a school repeatedly suspends a child, as punishment for the same or similar behaviors, then it is moving into dangerous legal territory. Repeated suspensions (even if each one is no more than ten days in length), create a “pattern” of administrative behavior that begins to look like an unstated change of placement (a denial of FAPE). Federal regulations warn schools not to suspend a student with disabilities for the same or similar behaviors for more than 10 days over the course of a single school year, because this begins to look like a change of placement.  If there are more than ten days of suspension during the year, the school district determines whether the suspensions constitute a change of placement, on a case-by-case basis– but parents have the right to appeal to the courts on the grounds that their child is not receiving FAPE.
If a school decides it wants to expel an autistic child, the IEP team must hold a manifestation determination review within 10 days after the decision is made. If the child’s behavior is found to be a manifestation of autism, then the child cannot be expelled. If the behavior is not found to be a manifestation of disability, parents have the right to call for a due process hearing, in which the IEP team’s decision will be reviewed by a hearing officer. Depending on the state, there may be a one- or a two-tiered system—in the former, the case is heard by a state hearing officer, in the latter, the case is heard first by an officer from the school district, and then (if the parents decide to appeal) by a hearing officer from the state. If the parents are still not satisfied, they can bring a civil law case against the school district.
This is the law as laid out in the amended text of IDEA and in federal regulations. Disabled students’ rights to a free, appropriate, public education must be protected. Unfortunately, though, far too many school districts do actually find ways of removing “troublesome” students without considering whether the “troublesome” behaviors are manifestations of the students’ disabilities, and without following the procedures required by law. I will discuss some of these practices in my next post.
 IDEA, part B, subpart E, section 300.536
 IDEA, part B, subpart E, section 300.530.
 Code of Federal Regulations, 2005. Title 34: Education. Section 300.536, “Change of Placement Because of Disciplinary Removals.” This regulation was added to the Code in 2005, to clarify the 2004 amendment of IDEA.
The traditional term for not speaking is ‘dumb.’ That says it all. If someone can’t talk then they are ‘dumb.’ I am dumb, apparently. The thesaurus offers these synonyms for dumb: among them mute, speechless, silent, and then fifty additional synonyms for stupidity, including the colorful pinheaded and dim-witted. The bias equating intelligence with speech…Civil Rights for Nonspeakers — Ido in Autismland
For a student with autism, diagnosis is always a double-edged sword. On the one hand, an official diagnosis may result in access to services such as ABA (for good or ill), speech therapy, occupational therapy, physical therapy, etc.; and for accommodations at school such as classroom aides, extended time on tests, access to quiet rooms, etc. It offers some legal protections against suspension or expulsion from school. At the same time, autism obviously carries a profound stigma in American society. In school, the child who has an autism diagnosis is often regarded by administrators, teachers and staff as different and potentially dangerous. Non-verbal autistics are usually assigned to special education classrooms, or even separate schools, where they usually receive only a limited academic education, regardless of their actual intelligence and potential. And despite privacy rules, autistic children’s diagnoses far too often become known to their fellow students, resulting in bullying.
Many parents are aware of these problems, and struggle with deciding what is best for their child, or sometimes what is best for the parents themselves, or for the rest of the child’s family. Should they seek a diagnosis or not? And if they do receive a diagnosis from a doctor or psychologist, should they share it with the school? Does their child’s need for services, accommodations, and protection outweigh the potential impact of stigma? But parental anxiety about stigma is only one of many factors affecting whether a child is diagnosed. Sex, socio-economic status, race/ethnicity, immigrant status, language and cultural differences, and even the place where a child lives, all play a role in determining who will be diagnosed and who will not.
“Four times as many boys as girls have autism.” This has been repeated so often that it may be treated as a simple fact. But the correct formulation should actually be that “four times as many boys as girls receive autism diagnoses.” We simply don’t know how many girls have autism. What we do know now, though, is that many girls on the spectrum remain undiagnosed because parents, psychologists and pediatricians don’t know what autism looks like in girls. For example: parents and care-givers are more likely to become concerned and more likely to seek a professional diagnosis when children engage in “externalizing” (aggressive) behaviors. But because girls are less likely than boys to behave aggressively, parents may not realize the extent to which they are “different” from other children, and as a result, their daughters may not be tested for autism until they reach school age or even beyond. In addition, most parents and professionals still don’t realize that autistic girls are better at “camouflaging” or “passing” than autistic boys, because they are likely to imitate the behavior of those around them (even if they don’t understand the reasons for that behavior), whereas boys are more likely to simply withdraw from social interactions altogether. The standard diagnostic criteria for autism present additional problems. Engagement in repetitive behaviors has long been a key criterion. But autistic girls are less likely to engage in repetitive behaviors than boys—and even when they do, these behaviors may appear at first glance to be normal for young females. Autistic girls may collect dolls or devote lots of time to coloring pictures. What parents and the professional responsible for diagnosis often don’t realize is that these girls are not playing with the dolls, but rather lining them up according to the color of their dresses; they are filling their coloring books with intricate patterns that have little to do with what’s going on in the pictures. As a result of these and other factors, girls are generally diagnosed at a later age than boys, and may remain undiagnosed into adulthood, even when they are quite severely affected by autism.”
Coming from a poor family also makes it less likely that an autistic child will receive a diagnosis. As one study found: “ . . . the proportion of children in poverty receiving services or supplementary income because of ASD was lower than the proportion expected on the basis of estimates of the prevalence of ASD in the general population.” While autism diagnoses have increased rapidly in recent years, the increase has been much lower for the poor than for other income groups. This is almost certainly because access to health care (and therefore medical sources of diagnosis) is much more limited for the poor in the United States, than for the middle and upper class. In countries with universal health care, such as Sweden and France, such differences do not exist.
Children of color are less likely than white kids to be diagnosed with autism. They are also more likely than white kids to be diagnosed late (after they have started school), or simply mis-diagnosed as having emotional or behavioral problems. The time from when parents become concerned to when the child receives an official diagnosis (if they ever do) is significantly longer for children of color than for whites. Even when socio-economic status and levels of parental education are factored in, these disparities remain. Among children of color, those most likely to be diagnosed are those with lower (or apparently lower) IQs, while those with the “milder phenotype” of autism (what used to be called Aspergers syndrome) remain under-identified. Fewer children of color receive early intervention services (such as ABA or TEACCH) for autism, and when they do receive services, it is generally for fewer hours a week. Once they reach school age, they are more likely than white kids to be identified as having “behavior problems” and are over-represented in school services targeting behavior (as opposed to social skills or learning techniques).  High levels of poverty in these communities, as well as prejudice, contribute to these disparities. Racial disparities in diagnosis and services affect all non-white children, but some groups—especially Hispanics and African-Americans—are more seriously affected than others.
Immigrant families may be poor and they may belong to racial or ethnic minorities, but they also face problems in receiving accurate diagnoses for their children simply because they are immigrants. Language differences can be a significant barrier, because so many of the diagnostic tools for autism are based on instruments originally written in English, and perhaps unavailable in, or poorly translated into, other languages. (Some immigrants may also be unable to read or write.) Lack of familiarity with American medical and educational systems may play a role, as do those systems lack of familiarity with other cultures. For example: many American practitioners view a child who is unwilling to make eye contact with them as potentially autistic. However, in many immigrant communities, children are taught that it is rude to look directly into an adult’s eyes. Some of the testing used to detect autism looks at children’s interactions with toys—but immigrant children may have never seen the toys presented to them, and may have no idea how to play with them “appropriately.” It is also possible that cultural differences may shape an immigrant family’s decision to seek a diagnosis. One study found that Korean-American families in New York City were often reluctant to seek diagnosis (or even discuss autism with others), because of the shame having a disabled child might bring on their family. This, and other similar studies, must be treated with caution, however, because they tend to be based on interviews with a very small sample of people, who may not be representative of the group as a whole. However, it is certainly possible that cultural differences play a role in immigrant families’ decision to seek a diagnosis.
Finally, there is the question of whether families who want a diagnosis and who have enough resources to get one can find someone to provide it. Other things (wealth, English language competency, etc.) being equal, it is not very difficult to find a doctor or psychologist able to diagnose autism in most of America’s big cities. However, one recent, if somewhat controversial, study, has identified a multitude of “diagnosis deserts,” especially in rural or thinly populated parts of the United States. 80% of U.S. counties have no autism diagnostic clinics. Families from these areas have to either travel long distances to find a qualified diagnostician, or wait until their children are old enough to receive diagnoses and services from local school systems.
Disparities in the ability to get an autism diagnosis are significant, and they have significant implications as well. In my next post I will concentrate on just one issue—the impact of having/not having an autism diagnosis on school discipline.
 E.g., “What is Autism Spectrum Disorder,” Center for Disease Control and Prevention website (current): https://www.cdc.gov/ncbddd/autism/facts.html; Deane Morrison, “Why Autism Strikes Mostly Boys,” University of Minnesota’s Office of the Vice-President for Research’s website (November 27, 1917): https://research.umn.edu/inquiry/post/why-autism-strikes-mostly-boys;
 Sylvie Goldman, “Sex, Gender, and the Diagnosis of Autism—A Biosocial View of the Male Preponderance,” Research in Autism Spectrum Disorders 7 (2013), 675-679; Lauren Little, et al., “Do early caregiver concerns differ for girls with autism spectrum disorders?” Autism: The International Journal of Research and Practice 21 (2017), 728-32;
 Jorieke Duvocot, et al., “Factors Influencing the Probability of a Diagnosis of Autism Spectrum Disorder in Girls versus Boys,” Autism: The International Journal of Research and Practice 21 (2017), 646-58.
 Rachel Hiller, Robyn Young, and Nathan Weber, “Sex Differences in Pre-Diagnosis Concerns for Children Later Diagnosed with Autism Spectrum Disorder,” Autism: The International Journal of Research and Practice 20 (2016), 75-84.
 Although this view remains somewhat controversial. Compare two recent articles in Spectrum News: Nicholette Zeliadt, “Diagnostic Tests Miss Autism Features in Girls” (May 13, 2017): https://www.spectrumnews.org/news/diagnostic-tests-miss-autism-features-girls/; and Hannah Furfaro, “Diagnostic tests don’t miss girls with autism, study suggests”: https://www.spectrumnews.org/news/diagnostic-tests-dont-miss-girls-autism-study-suggests/. It is worth noting, however, that the study described in the second article looked at girls already diagnosed with autism—which undermines its main point.
 Rachel Hiller, Robyn Young. and Nathan Weber, “Sex Differences in Autism Spectrum Disorder Based on DSM-5: Evidence from Clinician and Teacher Reporting,” Journal of Abnormal Child Psychology 42 (2014), 1381–1393.
 Rachel Hiller, Robyn Young, and Nathan Weber, “Sex Differences in Pre-Diagnosis Concerns for Children Later Diagnosed with Autism Spectrum Disorder,” Autism: The International Journal of Research and Practice 20 (2016), 75-84.
 Maureen Durkin, et al., “Autism Spectrum Disorder Among US Children (2002–2010): Socioeconomic, Racial, and Ethnic Disparities,” American Journal of Public Health 107:11 (2017), 1818-1826. See also Pauline Thomas, et al., “The Association of Autism Diagnosis with Socioeconomic Status,” Autism: The International Journal of Research and Practice 16:2 (March, 2012), 201-13.
 C.D. Pulcini, et al., “Poverty and Trends in Three Chronic Disorders,” Pediatrics 139:3 (March, 2017).
 Maureen Durkin, et al., “Autism Spectrum Disorder Among US Children (2002–2010): Socioeconomic, Racial, and Ethnic Disparities,” American Journal of Public Health 107:11 (2017), 1818-1826.
 Amber Angell, et al., “A Review of Diagnosis and Service Disparities Among Children with Autism from Racial or Ethnic Minority Groups in the United States,” International Review of Research in Developmental Disabilities 55 (2018), 145-80. See also Jason Travers and Michael Krezmien, “Racial Disparities in Autism Identification in the United States During 2014,” Exceptional Children 84 (2018), 403-19. Travers and Kremien pay special attention to differences between states in racial disparities; these differences can be quite significant.
 Emily Sohn, “Why Autism Seems to Cluster in Some Immigrant Groups,” Spectrum News, 11/29/17.
 Christina Kang-Yi, et al., “Influence of Community-Level Cultural Beliefs about Autism on Families’ and Professionals’ Care for Children,” Transcultural Psychiatry 55 (2018), 623-47. But compare the following three studies, each of which comes to a different conclusion about Mexican immigrant mothers’ attitudes towards autism: Elizabeth Ijalba, “Hispanic Immigrant Mothers of Young Children With Autism Spectrum Disorders: How Do They Understand and Cope With Autism?” American Journal of Speech-Language Pathology 25 (2016), 200-13; Shana Cohen and Jessica Miguel, “ Amor and Social Stigma: ASD Beliefs Among Immigrant Mexican Parents,” Journal of Autism and Developmental Disorders 48 (2018), 1995-2009; Brenda Barrio, et al., “The Impact of Culture on Parental Perceptions about Autism Spectrum Disorders: Striving for Culturally Competent Practices,” Multicultural Learning and Teaching 14 (2019), 1-9.
 Hannah Furfaro, “New Autism Map Points to Diagnostic Deserts in United States,” Spectrum News, 8/28/19:
It is perfectly possible to reduce both the frequency and violence of student meltdowns, which will, in turn, reduce the need for restraint and seclusion in schools. However, this requires a change in attitude on the part of educators, towards seeing autistic children not as willfully naughty or manipulative, but as overwhelmed and frightened. Teachers, aides and other educators also need to be willing to observe these children’s behavior carefully and make “meltdown plans” in advance. Given the already heavy burden carried by educators today, this may seem like a lot to ask, but dealing effectively with meltdowns will certainly reduce educators’ stress in the long run.
The best practical advice for teachers on this subject that I have found comes from three books. Deborah Lipsky and Will Richards’ Managing Meltdowns: Using the S.C.A.R.E.D. Calming Technique with Children and Adults with Autism focuses on interventions that can be used during a meltdown. Deborah Lipsky’s From Anxiety to Meltdown: How Individuals on the Autism Spectrum Deal with Anxiety, Experience Meltdowns, Manifest Tantrums, and How You Can Intervene Effectively, and Geoff Colvin and Martin Sheehan’s Managing the Cycle of Meltdowns also offer guidance on ways to prevent (or at least limit the number of) meltdowns in the first place. Lipsky is herself autistic, has experience working as and for first responders (EMTs, firefighters, police officers), and writes from the perspective of her own personal experiences and those of other autistic people she has worked with. Her collaborator for the first book, Will Richards, is a clinical psychologist, with extensive experience treating autistic clients. Colvin and Sheehan are professional educators who have spent decades working with autistic children in schools. Despite their very different backgrounds, their conclusions are remarkably similar.
All these writers clearly distinguish meltdowns from temper tantrums. And all of them describe melting down as a process, which can be interrupted by an observant and skilled teacher or first responder. Colvin and Sheehan propose a six-phase model of the “meltdown cycle,” in which a student who had been in a state of calm is subject to one or more triggering events, which then lead to increasing agitation until the point of no return is reached and he or she melts down. Once the meltdown has played itself out, there is a period of re-grouping during which the student is beginning to recover but may easily melt down again if pushed too hard. Finally, the student becomes calm enough to start over, although with some lingering anxiety, uncertainty, and irritation. Lipsky does not present her observations in quite the same way, but a careful reading of her book shows that she holds a very similar view of the meltdown as a process.
“Avoiding it in the first place is the most effective way of preventing a meltdown.” Both Lipsky and Colvin and Sheehan offer extensive advice on how to maintain a student with autism in the calm phase, which essentially comes down to using best practices for teachers of autistic students: providing sensory diets as needed, using visual supports, having clear rules (systematically taught to the whole class), planning ahead, and adjusting the curriculum as needed. The three authors also encourage teachers and aides to identify and limit as much as possible triggers that may disrupt a student’s calm participation in class—whether these are sensory issues, unexpected breaks in routine, or something else.
Teachers must also learn how to recognize the signs of increasing agitation, and how to intervene to de-escalate the situation with reassurance, comfort, and support. According to Colvin and Sheehan, agitation is “normally an observable manifestation that something is wrong with the student.” While some students move very quickly through the agitation phase to a full-blown meltdown, offering little time for intervention, much more often there is a period of agitation during which an observant teacher will notice increased stimming, wriggling, pacing and noise-making, or decreased interaction with others, including partial or total loss of the ability to communicate, non-compliance with directions, covering eyes or staring into space, hiding hands or even seeking isolation. Training teachers to recognize these signs can have a huge impact on the frequency and violence of meltdowns in their classrooms. When an autistic student is becoming agitated, the teacher or classroom aide can step in to provide reassurance and empathy, offer opportunities for breaks or for movement to quiet spaces, and encourage self-management (if the student already has some skills in this area). Reducing an autistic student’s agitation is the key to preventing meltdowns. It is essential that school personnel not become agitated themselves during this phase, as this will simply increase the student’s agitation and make a meltdown more likely.
If a teacher misses or ignores the signs, the student’s agitation will continue to increase until they reach a “point of no return,” after which a meltdown is going to occur no matter what. And once the meltdown begins, it will need to run its course, which typically ends when the child is too exhausted to continue. School personnel and school police officers must recognize that at this point the student cannot control her or his behavior, and neither can they. Shouting commands at a frightened child in the middle of an instinctual fight-or-flight reaction can only make the situation worse. Instead, the school should already have decided on an action plan and included it in the student’s IEP. (Obviously, if a child is having meltdowns in school, he or she should have an IEP). Staff should be trained in advance in ways of providing support for the melting-down student, by limiting additional sensory input, remaining calm, staying nearby (but not too close), and saying encouraging things in a low-pitched, slow voice. According to Lipsky, the calm and sympathetic use of the student’s name during a meltdown can be especially helpful. Educators should know how to calmly and quietly guide the student to a safe place and the meltdown plan should always ensure that someone observes the child while he or she is there. If there is an immediate threat of injury to the student or those nearby, strategies should be in place for using (and later reporting) safe forms of restraint as a last (not first) resort. Under some circumstances it may be better to clear the classroom of other students, until the meltdown is over. 
When the meltdown is past, it is cruel and counterproductive to criticize the student—who is physically and emotionally exhausted, and probably already deeply embarrassed about/ashamed of what happened. It should be unnecessary to say that police involvement after the meltdown is ended can only be counterproductive. Neither is it useful to interrogate the student about why the meltdown happened. (Discussion of the meltdown can occur sometime later—perhaps even the following day.) Autistic children are still emotionally labile during the “regrouping” phase and may escalate into a second meltdown if pushed too hard. Rather, the teacher or an aide should continue to offer quiet support and can encourage the student to use a stim toy or pursue their special interest as a way of bringing them back from the fight for survival into the ordinary world.
Eventually, the student will return to a non-agitated, relatively normal state during the “starting over” phase, and can return to the classroom (if they left it during the meltdown). Nevertheless, they may still be feeling some anxiety, irritability, or uncertainty, and should not be pushed too quickly to engage in normal learning activities. Concrete tasks, which the student has already shown he or she can perform, are the best activities for this period; engaging in such tasks can help the student gain confidence and eventually return to their original state of calm.
Good teachers here and there throughout the United States
have already learned how to manage meltdowns successfully, using these or
similar techniques. It is time for such
techniques to become standard practice in all of our schools. But it all starts with changing the attitudes
of the adults involved towards the autistic students they serve.
 Grafton Integrated Health Care, a for-profit behavioral health organization, has claimed that its proprietary “Ukeru model” has reduced incidents of restraint by 99% and incidents of seclusion by 100% over the course of 14 years (2003-2016), in community as well as institutional settings. They claim that staff injuries from restraint have declined by 100% in community settings, and 97% in institutions: Jason Craig and Kimberly Sanders, “Evaluation of a Program Model for Minimizing Restraint and Seclusion,” Advances in Neurodevelopmental Disorders 2 (2018), 344-352. The authors of this paper are affiliated with Grafton, and I have not been able to discover any corroborating analyses conducted by unaffiliated scientists.
 Deborah Lipsky and Will Richards, Managing Meltdowns: Using the S.C.A.R.E.D. Calming Technique with Children and Adults with Autism (London: Jessica Kingsley, 2009); Deborah Lipsky, From Anxiety to Meltdown: How Individuals on the Autism Spectrum Deal with Anxiety, Experience Meltdowns, Manifest Tantrums, and How You Can Intervene Effectively (London: Jessica Kingsley, 2011) and Geoff Colvin and Martin Sheehan, Managing the Cycle of Meltdowns for Students with Autism Spectrum Disorder (Thousand Oaks, CA: Corwin, 2012). Another excellent book on this subject is Judy Endow’s Outsmarting Explosive Behavior: A Visual System of Support and Intervention for Individuals with Autism Spectrum Disorders (Shawnee Mission, Kansas: Autism Publishing Company, 2009).
 Lipsky and Richards, Managing Meltdowns, section entitled “Are Meltdowns and Temper Tantrums the Same Thing?” (I am using the Kindle edition of the book, which has no page numbers); Lipsky, From Anxiety to Meltdown, p. 108, 135-42, and especially 149-52 (on determining whether behavior is a tantrum or a meltdown). Incidentally, Lipsky also offers some very useful suggestions for dealing with tantrums, even though her main focus is on meltdowns: see pp. 142-49Colvin and Sheehan, Managing the Cycle of Meltdowns, pp. 22-25.
 Colvin and Sheehan, Managing the Cycle, pp. 29-30.
 Lipsky, From Anxiety to Meltdown, see especially, p. 127. Judy Endow has a similar model: Outsmarting Explosive Behavior: A Visual System of Support and Intervention for Individuals with Autism Spectrum Disorders (Shawnee Mission, Kansas: Autism Publishing Company, 2009), pp. 11-46.
 Lipsky, From Anxiety to Meltdown, p. 229.
 Colvin and Sheehan, Managing the Cycle of Meltdowns, pp. 63-108; discussion of potential triggers is a particular strength of Lipsky’s book, From Anxiety to Meltdown, pp. 161-214.
 Colvin and Sheehan, Managing the Cycle of Meltdowns, pp. 40-43; Lipsky and Richards, Managing Meltdowns, section on “What Are Some of the Warning Signs of a Potential Meltdown?”
 Colvin and Sheehan, Managing the Cycle of Meltdowns, pp. 109-22.
 The phrase “point of no return” is used by Judy Endow, Outsmarting Explosive Behavior, pp. 35-40. She uses it to emphasize that once a child has reached this point they are no longer in control of their behavior; making a meltdown inevitable.
 Lipsky and Richards, Managing Meltdowns; Lipsky, From Anxiety to Meltdowns, pp. 216-22; Colvin and Sheehan, Managing the Cycle of Meltdowns, pp. 135-36
 Lipsky, From Anxiety to Meltdown, p. 221.
 Colvin and Sheehan, Managing the Cycle of Meltdowns, p. 123-41; compare Lipsky, From Anxiety to Meltdown, p. 221.
 Lipsky, From Anxiety to Meltdown, pp. 110, 126, 141.
 Colvin and Sheehan, Managing the Cycle of Meltdowns, pp. 142-53.
 Colvin and Sheehan, Managing the Cycle of Meltdowns, pp. 49-51, 154-68.