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Transcripts For CSPAN Today In Washington 20091228

built so that the bank on the discounts of the you can make money by using the local currency. host: do all of the locals use it? caller: most of them do. it is for those who do not want to see the money going to the walmart headquarters. we want to keep our money locally instead of going out of town. host: thank you for your calls this morning. that will do it for this morning's "washington journal." we will see you tomorrow. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] . . q>> by the time lawmakers retun in january, leadership hopes to have many of the major points of disagreement on health care worked out. the house returns january 12 and the senate will be back on january 20. live now on c-span 2, american university as toasting their annual two-week seminar for people working in local, state, and federal campaigns. this event looks ahead to 2010's key races and examined voter outreach initiatives as well as the boards of polling and survey research in politics. like all the coverage on c-span 2. -- all day coverage of cspan 2. today, a senate hearing on the national debt with the former congressional budget office director, the core controller general and others, the principal debt holders and a possible way to reduce it in coming years. that is 4:10 p.m. eastern europe to spend. >> all this week, a rare glimpse into america's highest court threw unprecedented on the record conversations with 10 supreme court justices. >> quite often, in many of our biggest decisions are ones that the court took that were quite unpopular and the idea that we should yield to what the public protest is is quite foreign to what it means to have a country under the rule of law. >> chief justice john roberts tonight and john paul stevens, interviews with supreme court justices, 8:00 p.m. eastern on c-span and get your own copy of our original documentary on dvd. it is par un cspan's american icons collection, a three-disc set. it is one of many items available at c-span.org/store. >> tonight, expending broadbent to a underserved areas of the country. -- expanding broadbent 282 underserved areas of the country. >> this thursday, a day of tribute to the u.s. and world leaders including the dali lama, ted kennedy, ronald reagan, walter cronkite, colin powell, and robert byrd. new year's day, a look at what is ahead for the new year. russian prime minister vladimir putin discusses his future from his annual call-in program. austan goolsbee on the global economy. the creator of the segue and a founder of "a guitar hero." plus, the art of political cartooning. about one in every 110 children have autism. that according to the latest estimate from the centers for disease control and prevention. the study was based on medical and school records of nearly 2800 children throughout the the national institute of mental health testified over the summer. other witnesses include the parents of autistic children. this is about two hours and 15 minutes. today's discussion is about autism. we don't know what causes this disorder. most researchers agree there is a general component in some cases. every discovery seems to raise more questions as it now looks at autism as not having one genetic cause but many. we still don't know what the z%tiggering mechanisms are. many experts suspect environmental factors may be at play. we still don't know what they are exactly or if they take effect during a child's first few months or years or maybe during gestation peri. behavioral interventions help it started early but we are aware near a cure at all. the number of people with autism continues to grow at the rate of incidence growing every day. this subcommittee has taken a strong interest in autism in recent years but we held a 2007 and the appropriations bill that was approved last week includes a range of autism outreach and education, surveillance, medical research, and the inter-agency coordinating committee. the bill also includes $40 million for a new program to help students with intellectual disabilities make the transition to college and complete their post-secondary education. we have an outstanding panel of witnesses today to examine what it is and from many different perspectives. research, treatment, interventions, and another problem that has not received enough attention to date, how to address the needs of the growing population of adults with autism. let me thank all the witnesses for coming here today. we we have two panels for the first panel is dr. thomas insul. we have covered all the aspects that we need to cover on autism with these two panels and first we will open up with dr. thomas insul, the director of mental health at nih. he has been here many times. as with you and with all the people testifying this morning, your statements will be made a part of dark record in their entirety. we ask you to go ahead and proceed as you so desire. >> thank you, mr. chairman. it's a real pleasure and honor to be here with the other panelists i know this is a very busy time for you and your colleagues. we greatly appreciate you taking time in the middle of the summer before recess to hear about the latest research and the latest challenge as with autism. my brief is to get to a quick update on research since we last met which was a little more than two years ago. this has been an extraordinary time. with lots of the extraordinary progress. we will try to review that. the testimony i hope will be submitted for the record rather than just reading it, i thought i would take to quickly approve three questions. what do we know at this point? what do we need? what are we doing? i will try to summarize those quickly to get to on track. :let me make sure we are on te same page in what we are talking about it autism by definition starts by age 3. we're talking about three very different kinds of symptoms that characterize autism, reduced social behavior, abnormal language, and repetitive restrictive behavior's that often are called steroetopies and that many other names. many children with autism, with additional complicating features. i listed a few of them here. some 20% - 30% will have a seizure disorder that can be part of the autism. intellectual disability of the various sorts -- we have many families were concerned about gastrointestinal problems of many different about 10% of children who have an autism label have bases or of appearances, we call that dysmorphic. up to 20% they have regression. while everybody make regressed to some degree, there are children who seem to develop quite well for the first 80 months and then will clearly lose language, lose function. -- first 18 months. understanding these complicated features and the fact this is such a heterogeneous in the room -- syndrome is that we talk about autisms. we think of this as many different disorders. we are prisoners of our own language by thinking about it as a single syndrome. the term that has now been most widely accepted and you'll hear about this morning is called the autism spectrum. that means that we're talking about a range within the syndrome from those children who really have very limited function and often have no language whatsoever, may have severe intellectual disabilities, showed no interest in social interaction, have lots of motor abnormalities, the most common we call hand-flapping, and they have the facial features. these are children who will grow up to be highly successful, some of them. they may have social awkwardness. they may be called geeky or nerdy or something like that. they may be more interested in numbers rather than people and they may be successful and make huge contributions as engineers and computer scientists in areas that will probably not tap into their social or does but allow them to use what they do best which is to be able to think about mechanical, numerical, and less social aspects of the world. all of those people fit within the spectrum. as you hear the debate about what is available and what treatments are and what the causes are, you have to remember that we are talking about this tremendous diversity within the spectrum. let's dive into what we actually know and what we have learned in the last couple of years that will be important for us in thinking about this as we go forward. first of all, there is wide recognition that this is a developmental brain disorder. we don't know yet where the bread or what in the brain or when in the brain things go off track. the most recent research would suggest that what we are talking about is not a specific leeson in a particular area. it may be more likely what we call a synaptic disorder. is a problem of brain connections. that may be very diffuse and it is quite possible that the reason you see problems in language and problems in social interaction is that those are functions which require the greatest number of synapses. they are unable -- they -- you cannot process information as quickly as you need to. or if you process it to quickly, you will see deficit. s in those kinds of functions. the greatest degree of progress has been genetics and that is not surprising. that is true in almost every area of medicine in the last three or four years. we are seeing an explosion of information from the genomics . benin it has not deliver the cures were looking for yet polished it helps us to understand more about this. two years ago i talked to you about how we think to know it would be a portrait at that point, we would have said is important because we know a couple of percent of the children who present with autism have recognized syndromes, rett syndrome and others, these are single gene mutations in which perhaps 50% of the children, maybe more, have an diagnosis of autism as well. we have discovered a range of other rare but apparently highly significant nutations that are in the form of structural lesions within the genome that also seemed to contribute. two years ago, i might have said may be 5% of any population of children with autism would have one of the syndrome, i think now we can see that number will be considerably higher, perhaps more than 10% per we don't have names for all the central spot we have in the last couple of years and it is changing almost every two months, there are reports that we're mutations that may explain another 2% of the children who have this disorder. there is clearly a genetic factor atxo work here that does not explain all of autism. we still need to learn a lot more about how genes and environment interact and there will be lot more research on that in the future. that is clearly an important area of progress. we spoke about this two years ago -- as you said in your opening remarks, behavioral interventions are helpful. they are especially helpful when their started early. you'll hear more about this from other panelists. the issue here is making sure that the best behavioral interventions are available to the people who need them. we're not just talking about children but also children in transition to adulthood and adults themselves. these do work but they are not always available and they are not always paid for it at least not paid for through insurance. we need to have a conversation later this morning about how that will happen. i would also recommend that you might want to ask dr. dawson about the impact of behavioral intervention pared some of her work in this area is really setting a new bar for help for these behavioral interventions will go if they are done early. finally, the issue that you brought up in your opening remarks and i know it is one that is of great concern to you specifically is the increase in prevalence. the centers for disease control and prevention and now reports from 2007 a rate of about one in 150 children, eight year-old have been given a diagnosis on the autism specter. -- spectrum. it is true that is about a 10- fold increase over the numbers coming from the cdc from the 1992-1993 period. the prevalence of great interest to many of us. i want to caution you that a change in prevalence is not unique to what is a very we have seen a 40-fold increase in the pulp bipolar disorder and a greater increase in attention deficit hyperactivity disorder in children. this kind of a change is not unique to autism. it is certainly one that deserves our attention and we have to remember the difference between prevalence which can be affected by ascertaining, by chance and diagnosis, and the difference in incidents which we don't have right now could evidence there is a true increase in incidents. bubbwe need to fill in the gapsf what we do not know. we need to understand more about the risk architecture of the whole spectrum. genes are important, environmental factors will be important, and most important will be how they interact. that is not unique to autism. it is true for asthma and many other areas of development. we want to know about molecular targets because that is what we're new therapies will come from and they have begun to emerge. we also want to understand the heterogenaiety. we want to detect the disorder much earlier. we know that brain disorders, behavior is one of the last features to change. that is true for alzheimer's, that is true for parkinson's, that is true for huntington's, and it would be important to note upstream by having a bio- marker to detect risk and attacked the disorder much earlier. we want to have interfacings -- interventions that are more affected. they are expensive, extensive, they take a long time to work and does not where we want to be at the end of the day. we want to offer much more than just behavioral interventions. we want to know which treatments will work best for which people. you'll hear a lot about personalized medicine over the next year. we are hoping that the new nih director will be confirmed by the full senate this week. should that be the case, you will hear from him the high priority put on personalized medicine. that is something we will be for autism as much as cancer and heart disease and diabetes. i want to point your attention to an issue that is not on the research agenda but needs to be on the social policy agenda. as you mentioned, we have a whole wave of children with autism who will soon be adults with autism. how we make sure that they have access to services and take care of the transition to independence and the coverage for the different kinds of care they need deserves urgent attention from this committee and from others who make policy. finally, let's talk about what we are doing. this can be summed up quickly through the work of the interagency autism coordinating agency. we have a plan which was released in january of this year. that provides a whole range of activity that we hope to be able to invest in so we can get some of the answers to what we need. we have an extraordinary opportunity now. when we first about this plan in january, the comment we heard was," this is a great road map but is there any gas in the car?" what happened soon after that was the opportunity to make some very substantial new investments to jump-start this strategic plan politically focusing on the short term objectives. we hope within the next six weeks to be able to announce publicly the large number of grants that have been funded through the american recovery and reinvestment act. this includes the special rfa threw five institutes to support new what is a resort to the tune of about $60 million but also a large monitor a challenge grants and grant opportunity awards that will be announced before september 30 of this year. we have tried to jump start much of this project by creating a data base which will be essentially a in a meeting ground for scientists around the world to share data and share the tools that are necessary to accelerate progress in this area. as you will see, there were six questions in the plan that guided the efforts, research, and to help us see what the most important issues are. the iacc which was charged through the combating autism act of 2006 includes public and federal members. these questions really came out of a very rich discussion about what it is it that families and people themselves of the autism spectrum most are looking for. we have taken each of these tomorrow we have come up with a summary of what we know and what we need for these six questions. we have no short-term and long- term objectives that are big contrast to recovery act -- that are being address through funding at the i will finish with a vision statement. this thoughts about what we are trying to do as we move forward and that is to inspire research that will profoundly improved health and well-being of every person on the spectrum across the life span. i cannot emphasize enough the importance of attention to adults and to become adults with autism. this plan will not only provide the road map for research but also set the standard for public-private cooperation and for engaging the broad community who will be so invested in trying to make sure we expedite research progress. with that, i will make one final comment -- i know you -- thank you for many things you have done for autism and four n i h and for many of the other issues you deal with. i would like to send a personal thank-you for giving us ellen marie who will join hhs reset very soon. this was a lot to give up but for those of us that hs, ellen murray is a delightful gift. thank you, sir. >> thank you very much. >> i am pleased to join you at this hearing to thank our witnesses who have come to share with us their experiences and thoughts about what we can do to more effectively deal with the challenge of autism. we have had hearings before. it is important for us to continue our efforts to stay up- to-date. we need to join forces with the victims and their families to help make sure we tramp and do not let the victims and their families down. we want to support the cause. thank you for being here to leave it off. >> thank you. >> thank you for your leadership. i am looking at the list of people on the committee. our interest is in research and finding causes b, which hopefully will lead to prevention and cure it we are also interested in early intervention programs. do you have enough expertise on this panel in terms of looking at that aspect? what are the effect of early intervention programs that we can find and work on? >>on the iacc specifically? we bring in the expertise. we have to update the plan every year by bringing in the experts in all areas we are concerned with. we have heard about both ends of the spectrum. the early detection and early intervention, we you like to use the term pre-emption when we can. this is a place where it needs a big push and the other end of the spectrum is adults on the spectrum who need a lot more in the way of interventions. > >> which treatments and intervention to will help? this interagency group, you are actively looking at different interventions and try to find out which ones work best? are you also promoting different types of interventions? are you instigating different types of early interventions to track them and see what which ones work the best? >> the first thing we did was to do a portfolio analysis. this was unprecedented. we asked not only an ihl and cdc and the department of education and all federal players including the department of defense that invests in this terrible also all the private groups which are very substantial players for autism. they are putting in significant amounts of research dollars. for the first time, everybody has shared their information about every grant they fund, how much they are put into it and we were able to use that to map onto these six questions and say what is missing. the place where we look like we are underfunded or under invested across the six questions is the area of intervention per how we fill them? we bring the experts on an annual basis to tell us what the needs are but the opportunities. what can we do and what is hot right now in terms of techniques or things that are going on and other areas in madison? the meeting this year will be on september 30 and october 1. we did a previous one in january of 2008. we used four days to hear from a broad panel of experts. to not only your typical academic grantse that you hear from but family members who may have had an interesting experience they think we should hear about. we are bringing in clinicians' as well who may be trying things that we don't know very much about. we are trying to pro as broad a net as possible to mature because all of the best ideas on to the table before we decide what we want to recommend for nih and cdc and the dod and others to look at for funding. >> we are talking about applied behavior therapy being successful? hourly and age can you start that -- how early an age could start that and do we know what age you to start at that? >> i will duck that question because the world's expert on that is sitting right behind me. you'll talk to heard a few minutes, dr. dawson, and i don't want to put her on the spot but she has just completed the landmark study on just that question. i would love to steal the thunder but because she is a friend and i don't want to alienate her, it would be better for you to hear from her. >> you will hear a lot of talk today as i hear about this issue of vaccines and what is a very tenuous summarized the state of the science regarding that issue? >> i can tell you what we know scientifically and that is that there is no question from the community there are environmental factors at work. some aspects of the environment is going to be interacting with genetics to make children and maybe even a unborn children vulnerable. it may be that these are prenatal environmental factors. the only factor that has been export at great detail would be vaccines. part of that has to do with increasing number of vaccines which have gone up over the last three years or so i made a slight to even see what that looks like. there has been a striking increase from 1900 to about 2009. there are more vaccines that are now in the recommended schedule. there are more injections and perhaps even more injections per visit that are possible currently. it is also important for you to realize that while the number of vaccines have increased, the quality of the vaccines have changed in the same time. if you look at the number of antigens that go into these vaccines, although it doesn't show it here, 2000 and 2008, the amount of protein that goes into the full group of vaccines that children are receiving is less than they were when you were getting a single shot in 1900 the vaccines are far more refined, far more targeted, they look very different than they would have even when your children would have been vaccinated in the 1970's and before. does not quite comparing apples and apples when you look at this change over time. the research has been focused on vaccines has association with autism and has been epidemiological research. up until this point, i believe there has been a total of 16 studies involving hundreds of thousands of children literally, and there is no evidence at this point of any association between vaccines, the number of vaccines, the kind of vaccines and the increase or the particular vulnerability to autism. >> what i don't understand is how you could have a study involving hundreds of thousands of children because they are all getting the same number of vaccines. i have a different charge from the center of disease control and prevention. it shows that in 1983 the maximum number of vaccine doses administered before age two was eight. in 2009, there is a minimum of 21, maximum of 29, and from everything i can ascertain, it is more closer to 29. we have gone from eight in 1983 to 29 this year. before the age of 12. most pediatricians do that. how would you find a group that does not get those? >> it is not -- the eight are not the same as 29 bird look of a number of additives that are present in 1983 versus what is present in the vaccines that a child would receive in 2008. there is a striking decrease these are not the same formulations. they are not the same kinds of vaccines. we are talking about while the numbers have gone up, there is a profound reduction in the amount of protein and a number of antigens. >> some of these vaccines weren't around in 1980. we have a number of them here -- some of these weren't even a round. they were around in 1980. >> right, and the vaccines that were round in 1980 have been changed. they are more for -- far more refined. they may have the same names but the formulation has been greatly refined. that is how you get these kind of changes. >> i get confused when we get into this area. i want to focus on the number of vaccines and the fact that they are all put together, many times, before the age of 12. two. just the total number has gone of apparent i don't know of any studies that would compare a cohort of children from 0 to age 2 that did not get these shots and the incidence of autism and those that did receive 29 vaccines and did come down with autism. i don't know of any study out there that has done this. >> we have had a discussion within the iacc about this issue about could we mount a study of all vaccinated vs un vaccinated children. we do not have vaccine expertise on the committee. we decided to consult the national contain -- national vaccine advisory committee. they report to the secretary and we want to get their expertise because they do have it. we met about one month ago to have this conversation. before meeting with them, we sent them the question, saying," has there been such a study?" their first response back to us was that it has not been done. they did not think it was feasible to do they did not think it was ethical. they have real concerns about the ethics of randomizing a group of children to not receiving vaccines started they were particularly concerned about the risk involved in not vaccinate a large number of children per year with a large number of children for such a study. >> so, we really can't tell that it. . i know people who are not letting their children get those numbers of vaccines. these people are highly educated, professional people. they have decided they will stretch them out over a long period of time for the woman given to them before the age of two, maybe by the age of five or six. i'm a lot of that is happening out there. many pediatricians will not treat a child if in fact they are not getting these immunizations. they tell parents that if they don't agree to the vaccination schedule, they cannot be a patient. i know a lot of people who are not having their kids vaccinator. i don't know the ramifications of that i don't advise that but i know that is happening. the problem is we don't know. we don't know if 29 vaccinations, immunizations by the age of 12 to have been a fa2 do have in effect. >> this is a topic that has come up. it is a highly-charged a topic. people are convinced that vaccines are the problem and some are not. there are both ends of the spectrum but we also hear from many families who have had a child with autism and they are wondering what they should do about their next child. that is often the question that is on the table because they don't know who to believe and what to listen to. the group of people who feel there really is an issue here and we should be concerned because there is a relationship between vaccines and autism point to the numbers that you point to, a large increase, and they say there have been 16 studies and all 16 studies demonstrate no relationship. however, those are all epidemiological study spurred you cannot rule out the possibility that there is a small signal there that might have been missed. on the other side of the coin, we are hearing from other people and not a scientist but family members of this committee who are saying, "enough already. if there is an environmental factor at play, we have spent a lot of money doing these studies and nothing has shown up on this question. maybe we don't need to turn that rock over a 17th time, let's move on and look at something bad is more likely to shed light on what could be an important factor in the increasing prevalence or risk for autism." that is what we are hearing. we are trying to balance both of those points of view and try to make sure there is information available for people who are most concerned about what they should do with their next child >> that is true. we have boat. th. how we help people right now who are dealing with children of their own? we have to focus on those early intervention programs. we'll get to that in the next panel. anything you wanted to talk about? >> i want to join you in welcoming dr. inseld to the hearing and recall that we have had hearings in the past and we have had efforts in the past to try to develop a body of information that will help us identify better ways of dealing with autism, what are the causes? what are the possible changes in environmental or nutrition, health care, that we can turn to for help? all this will help to deal with the sorrow and challenges and difficulties that autism brings to our society. i can recall back in mississippi, join with families there to help raise money, have benefit of vans, go on television, invite people to attend and contribute and the like. some of the experiences that i had banned, observing the children who were victims of autism and talking with families and getting to know no more about it, really make a big impact on me and how challenging this situation really is. my heart goes out to those families who are dealing with it. i want to be here today to support the effort to identify how government can be more helpful. what are the other possible causes for autism? what are the things that we can do and continue to work and not give up. many people have invested time and effort and research and dollars, personal energies to cope with the situation ve. is there hope? have we discovered things and learn things over the last several years that give us any hope we are making progress? >> absolutely, there is always hope but more than that, there is very rapid progress. this next period of time will be even more extraordinary. we are ramping up the investments of very rapidly. in 2008, our budget brought to some research at nih went up 25%. in 2009, it will go up much, much more than that because we are seeing this recovery act effort. we have put money specifically into an autism request for application into the recovery act. the only disease-specific request in the recovery act from and i age for this year. we have lots of other things going on with the $10.4 billion but this is the one that has a disease name on it and because we realized that there is an urgent need and there is a tremendous opportunity right now for progress toward we have the tools we need we can start to move quickly. we want to do that over the next two years. >> thank you very much for your efforts and being involved as the director of the institute for mental health. we appreciate you being here this morning and helping us fully understand the challenges we have ahead. >> thank you for your interest and support. >> would like to call our second panel -- we would like to call our said improper if you can stay, we would like you to stay. >> i would be happy to stay. i want to hear the c-panelists. >> do you want to say appeared? >> will do. >> you don't have to mow. you can stay right there. [laughter] dr. geraldine dawson, mr. joshua cobbs, miss nicole aikens boyd, david miller, and dana halbersonn. thank you all for being here. some of you have come a great distance. your statements will be made a part of the record in their entirety and if you can summarize five minutes or so, i would appreciate it very much. we'll start from left to right. dr. geraldine dawson, the chief science officer for autism speaks. she was a professor of psychology and psychiatry at the university of washington. she is the founding director of the university's autism center. she received her ph.d. from the university of washington. thank you very much an please proceed. >> good morning, mr. chairman. i want to thank you for inviting me. i am very ironed to appear before the subcommittee. i want to thank the committee members and you for your leadership and -- in providing full funding for it become bidding -- combating what is impact. also for your appropriations bill. this year, more children will be diagnosed with autism then with aids, diabetes, and cancer combined. autism research is still significantly underfunded despite greater public and congressional awareness. for example, leukemia affects one in 25,000 people but receives research funding for $310 million annually. pediatric aids affects one in 8000 children. ts its funding is tutored $55 million per year per it autism affects one in 150 individuals and yet nih funding for fiscal 2009 is estimated to be $122 million. most scientists agree that autism is caused by a combination of both genetic risk factors and environmental factors. we have discovered some of the autism rest jeans. we still know very little about the role of the embargo and how it interacts with these genes. we have come to understand that autism is not one disease but many different diseases that as many different causes and each costs will likely only explain a minority of cases per piece by piece, we must discover each of these causes so that effective are effective for some individuals, most individuals with autism suffer without relief from the autism itself and a wide range of medical conditions such as sleep disorders, gastrointestinal problems, and epilepsy. very few clinical trials have been conducted that address these medical conditions. virtually no cost effective studies have been conducted to determine which treatments are most affected. parents are left to sort with confusing and often inaccurate information about the various treatment options and claims per it clinicians are often at a loss in helping parents to make evidence-based treatment decisions for this kavanagh system -- this gap must be filled. adult care accounts for the bulk of the billions of dollars that is spent annually for caring with individuals with autism in the united states for it on like other health conditions, we have limited information about autism health care utilization, barriers to access, health care disparities in the u.s., or cost-effective as models. over the past two years, your subcommittee and you have been responding to the challenge of autism with resources. this is beginning a midlevel fight against is very challenging disorder. more is needed to better understand the order, diagnose it, and better treat those individuals who have it. i want to end by thanking you for your time, your commitment, and for leadership. i am very happy to entertain any questions that you may have. >> thank you parted before we go on, i want to recognize my good friend and colleague from pennsylvania with whom i have shared the gavel over the past 20 years. senator specter is a member of the judiciary committee durin. he is on the floor now with the supreme court nomination. >> thank you for yielding. we are taking up the confirmation hearings of judge sotomayor for supreme court and by and do on the floor. i want to thank you, mr. chairman, and ranking member cochran for having this is airing of this very important subject and think the witnesses for coming in. autism is a heartbreaking element. of the many issues we have to face, among the toughest is talking to parents who have children who suffer from autism. there is a question of doing more. senator a harkin and senator cochran and i have worked hard on funding for the national institutes of health. for a decade, we were able to raise funding from $12 million - $30 billion. regrettably, that is not enough. i know that funding for autism was slightly under $52 million in 2000 and up to 122 built -- million dollars now. the cdc spending has increased from a little over $1 million to a little over $22 million. we have been successful in getting into the stimulus package, a $10 million, as you doubtless know. it is my projection that some of that will be going to autism. these funding levels were set by nih in order to avoid politicization. i think there should be a bigger share for autism. we are pushing to make that happen. we're working on comprehensive health care reform and we are trying to get $10 billion added as a base to start with. that would give us a better opportunity to do more on this very, very important element. i want to express those views today. staff will be here to follow your testimony and we will have a chance to review with gary we appreciate you coming in and you have our schurz's that we will do everything we can on this very important matter. thank you, mr. chairman. >> thank you, senator specter. now, we will go to mr. cobbs. if i remember right, you are from ottawa? near sioux city? -- you are from iowa? your wife is with you? >> she is in the audience for ? >> yes. you weren't you here at our last year? >> i was. >> you have been ball than the tele-health program with your young boy, noah? >> that's right. >> i am interested in what is happening last couple of years, please proceed. >> good morning mr. chairman. my name is josh cobbs. i'm a parent of a child with autism for it it has been over seven years trying to better the lives of individuals and families affected by autism through insurance and education reforms. when i was left in front of this distinguished committee, i spoke of the successful and cost efficient services myself received using tele-health technology. this came from professionals in florida which was federal sponsored national research project rate we are one of 15 families that participated in this demonstration across the nation. in this model, after a brief& phase of face-to-face training which is crucial to build a therapeutic relationship, we relate to professionals by an interactive video systems that enable live tree, consultation and support directly into our home, when and where we needed it. through this model, we receive professional support in teaching our some language, life skills, and overall improving his quality of life. one of the main components of the study was the reduction in our family stress preparing us as frontline teachers and therapists. through training and education, we have a better understanding of our child condition and those things we could do to bring to bear to improve his life. not only did improve his life but it had an impact on my love and my family as well. we showed a dramatic reduction in stress as a family and became more focused as a family unit. i will never forget the call from my wife saying, "you'll never guess what are some dead. he went party on the big boy ipod." -- p he otty on the big boy potty." through our connections and access to certify professionals, we were given the right to skills and were able to achieve what previously was unobtainable. our experience was chronicled in a two-part series filmed by the abc affiliate in sioux city, iowa. we have copies of the footage that we would like to share with the committee and it can also be viewed www.celestefounda tion.org. the treatment does not conform to a clinic hours. we were able to access the professionals when we needed and it made all the difference. just having the support of my home allowed natural interaction for my son and allow the professional to see# o the behaviors as they occurred. as chairperson of the iowa autism council, i have the opportunity to speak with family members within the autism community to learn there in a separate from my perspective and my experience, these families are desperately in need of services. as parents a search on live for appropriate health services for their children, they are confronted with an array of on validated technologies and various individuals claiming expertise in treatment. there are no safeguards in place to protect vulnerable parents and children. from anywhere in the world, anyone with a personal computer can offer video services termed as advice. under these circumstances, any individual or group can claim qualifications in helping children and parents with autism. families are experiencing the emotional burden of treating a job with this bill is but they have the financial burden of paying for this treatment with no assurance as to the quality of care provided. when individuals or organizations that are collecting fees for services can distance themselves, what can families expect for recourse? the reality of standard setting is evident because without standards, there can be no reimbursement while the method and systems are cost-effective, without proper reimbursement model, they remain on untenable for most parents. -- un of tenable for most parents. -- unobatainable for most parents. the current wave of statewide health insurance requirements and to provide reimbursements for individuals with autism does not have well-defined standards for tele-health reimbursements. families and children are not granted access to effective care as a result i know this committee has recognized the need to assess "best practices and professional criteria status and make recommendations concerning national standards for tele-health reimbursement which encourages this technology." i commend the committee for such injuries owners that this momentum continued. in closing, you may be wondering how my son is doing today. he is now 9 years old. my family is still familytele- health technology. it is important to note that as my son grows, his treatment program continues to grow and addressed his ever-evolving needs. we continue to use this treatment because it has been effective for our family. it has been so effective that now my 8-year-old daughter has become a mini-therapist. my son continues in the role of student and teacher to us all. indeed, his future is bright. i would like to thank you for your time and the opportunity to share our story and the stories thousands of families. thank you. . >> i want to thank the committee. in 2005, our family was living in texas when my husband completed his surgical fellowship. my child developed progress of autism. almost overnight, he digressed from using words and sentences in two languages and well above his peers to someone who who lost almost all of their skill sets. it was as though a tornado had hit airlines. -- had hit our lives. my son began a vigorous program that has continued after our move back to mississippi. we can see progress and we're cautiously optimistic about the future. he is quite verbal and his motor skills have improved. his medical condition is always tenuous. simple viruses will turn high- functioning children into a low- functioning child in a matter of hours. today he will attend his kindergarten open house in mississippi. he will attend a regular education class and have some assistance. as the class of 2022 starts kindergarten, schools look very different. 20 years ago, fayed would have been -- he would have been the only child with autism. however, his kindergarten class of roughly 200 students will of six children diagnosed with autism spectrum. if you do the math, and is roughly one in 34. in mississippi, we know that children typically do not get diagnosed until much later. that number is probably going to go higher. this is a high number compared to what we see in national statistics. i think you'll see this number replicated in kindergartens throughout this country. we know that the rates of autism close-up 10 to 17% per year. can you imagine what autism will look like in this next decade? the medical establishment gives itself a pat on the back saying they're doing a better job diagnosing this. we know there are contributing factors so that the root of autism increases. it does not explain the explosion of boxes and we're seeing in america. we oftentimes see a relationship between pediatricians and family members who believed the autism was caused by vaccines. we see relationships when parents do not accept that there could be multiple causes of the autism. we reached an impasse in trying to help the child. the autism society currently estimates the lifetime cost of caring for a child with autism is $3.5 million to $5 million. we are looking at facing a $90 billion cost in funding autism. the question we need to ask is, can we afford not to put the money into research and treatment if these are the numbers we're looking at. i am glad you were sitting beside me. the combating autism bill brought great hope to parents. we appreciate your help in passing that. however, we have to move quicker. we have to see the committee look at all aspects and possible causes to autism. we have to see that committee quickly makes some identifiers and look at populations of these children to find out what of the general pictures that we say, what are some health indicators we see it? it has to be done quicker than we usually operate at government broker c levels. the other thing, i would be remiss in representing the parents if i did not go back to your question, senator harkin. we have to look at the causation with vaccines. dr. bernadine healy, who has testified before this committee many times, has noted there is a dearth of research in truly looking at the vaccine autism connection. there is some very good studies that are yet to be done. i know this committee and this senate does not like to tell the nih have to spend as research dollars. but i ask that you particularly look at this, particularly when you're confirming a new nih director. i want to give you some optimism. in this classroom, five of the six children have received intensive behavioral therapy. their families have taken two jobs to be able to afford this behavior therapy. that is not often the case in mississippi. with mississippi, the average annual income is less than $35,000 a year. this private intensive behavioral therapy costs around $50,000 a year. it is impossible for many of the constituents back home to afford the therapy that they know will make a child better. on behalf of those misses sabaeanmississippians, these chi mentioned have received intensive behavioral therapy even at the age at5. they already are requiring less classroom support than they would have. you can see the financial bright spots down a road with this intents a behavioral therapy. so the question i will leave you with is, if we know that we are looking at day $90 billion annual health care cost and we're looking, and i will take the information and we're looking at initial investments around $32,000 a year, and over the child's life, we can see health care returns roughly at about $2.5 million of health care savings for those children who get this, the question is, can we afford not to make their investment? >> it very profound statement. thank you very much. now we will turn to david miller, a resident of fairfax county, virginia. he co-founded a community college consortium on autism. he received his degree at boston university and has a master's at northeastern. retired from the armed forces. he is the father of two autistic boy is. mr. miller. >> thank you. chairman harkin, thank you very much for holding this hearing. i am board member of northern virginia community college or recommend -- or represent -- as you indicated, the co-founder of the college consortium, which is comprised of 41 presidents of colleges fromthe have the highest incidence of autism in the country. he is an active member of for a consortium, as is the president of heinz college, the largest community college in mississippi. both of these leaders could not be here today because of previous a scheduled board meetings. we do have some college presidents that are here. the first one is behind me, he is determined of taft college and is the chairman of our consortium. the second president we have is dr. wayne burton, the president of north shore community college based in massachusetts. we have steve, the chairman of passaic county community college. we have one of the foremost post secondary programs in the country for students with autism. if you look at my testimony, the summary of the results that taft has rachieved, it is astounding. we aspire to the programs as effective as the taft program. this hearing has a particular poignancy to me because i'm the father of all autistic boys, identical twins. their sister is the youngest of these triplets. she is here today. she is a happy, healthy 7-year- old princess. i know you're back there somewhere. my comments are those of a parent who is concerned about the long-term ability of my children to live independently and to develop a career track that will enable them to support themselves financially while meeting and overcoming the challenges that we have never faced in our lives. i am not an educator. i am not a therapist in the field, like jeff ross. i am not as well read as my wife is. in terms of the nocturnal tendencies of an autistic child, my wife should be seated here. i would like to -- people talk about takeaways. i will go to my testimony in a moment. and when you want to further the activities, there are two takeaways. my kids are here. they are here to stay. what we're doing in terms of research is excellent. we need to have all of that good stuff. it is tremendous. my kids are here. all panelists who have autistic kids are here. the second thing i find more and more is, what is the game plan here? what are we looking towards? it is true most of these kids are below the age of 17. more and more, the kids are entering middle school and high school. it will be adults. it is a critical question that we have to consider. we have to keep that objective in mind. we are seeing our first beginnings of autistic kids on our campus. you're chairman, chairman kennedy, gets it. we have had a number of discussions. he has called this a tsunami. he said we're not investing in the infrastructure to do with this tsunami. a bill authorizes five-year grants in support of a model program to promote the successful transition of students with intellectual disabilities. there is no specific amount of the rise. i have a letter. i am sure you have seen it. their request $35 million for 2010 to fund these types of programs. as stated, the vast majority of autistic students are currently at community colleges and will attend community colleges because we have open enrollment policies. they reach age 21 and they come to our campuses. we have no effective programs to deal with these children. they come to our campuses and in role in normal academic courses. there soon academically dismissed. they have no further contact with respect to job training program and. the have no further or additional educational opportunities. so what happens to these kids after that? that is what senator and kennedy is focused on. schools like kirkwood will tell you these are expensive programs. their run $30,000. there are limited by law to approximately $3,000 as far as tuition. they do not have access to any further funding. they just do not have the financial resources to develop programs to assist these students. i think one thing, and i realize i am over my time. these funds are essentially economic development funds. stimulus funds. they are being focused by community colleges. again, we appreciate the fact that you see fit to put approximate $15 million towards this program. we hope that you will walk away at least without minimum amounts of money. >> thank you very much, mr. miller. now miss dana halverson from iowa. i should have looked at that before i said it. that little clip could be misinterpreted. she lives on a farm in iowa. well up in northwest iowa. her daughter robin was diagnosed with autism when she was 15 months old. she has a degree from the university of minnesota. welcome. please proceed. >> she was diagnosed a little over age 3. she regressed. >> would you punched the button? thank you. go ahead, halverson. >> thank you, mr. chairman, for this opportunity to encourage more thought and action on autism. my name is dana halverson. my days are filled from very early to very light with challenges of my three children. i have one daughter who was diagnosed over age 3 with autism and mental retardation. she was given the label of autism, it fails to describe the nature of her disorder. i discovered her condition. over the next several years, we confirm multiple medical diagnoses, multiple food allergies, growth hormone deficiencies, and to grant discretiimmune dysfunction, andy metal toxicity. we have only been able to help problem by struggling to travel all over the country, spending thousands of dollars on tests and clinical visits, mostly not covered by insurance. the list of diagnosis she carries is long for a young child. this belies her medical problem. people expect her to be able to respond to them and share with them. robin has come a long way but still has difficulties. i know of trojan who of fully recovered with proper therapy. -- i know of the children who have fully recovered with proper therapy. we hope that someday she can live a normal life. once we learned of her medical issues, and she began to improve. these symptoms we see in robyn are not psychiatric in origin, needing only psychological therapy. autism is a disorder with behavioral characteristics. many families hesitate to use the word "autozone." we call it the a word. -- many families hesitate to use the word "autism." i have discussed causes and treatments. no action has been taken. more children have suffered and more families have been destroyed. the financial burden will fall to their parents and also to taxpayers as some of the older children cannot work and must collect disability checks. care will cost millions of dollars. i have to accept new york invitation to set the record straight. you cannot address the a-word without addressing of a-words. we have the sickest generation of children in 60 years. one in six children has some form of narrow developmental delay. alice huang 150 have often is -- at least once 150 have autism. this is essential to obtaining answers. agencies charged with protecting the health of our children suffer from conflicts of interest. the need to be held accountable. it is difficult to sit at this table and tell you you haven't lied to, the would have all been lied to. mercury levels exceeding eps say it levels were in robin's vaccines while pregnant and after her birth. the industry material safety data streets identify the chemicals as follows. the mercury component has caused nervous system effects in experimental animals including mild to severe retardation and motor impairment. you do not need to take my word for. a doctor and a former associate director of the national toxicology program is with me today. he has on many occasions shared his views of the danger these chemicals have cost two children. the number of vaccines has risen from san to 49. those who create vaccines often said at the table and reap the dollars of the vaccines being used. where else in the world to see the scenario of no accountability and conflict of interest? elected officials and very few are doing it. we need transparency, honest communication, and as you suggested, a valid, unbiased study of vaccinated versus on vaccinated population. congress scrambled to hold hearings about steroids while thousands of children have continued to be injected with the vaccines containing a known neurotoxin. we all know some children are injured by vaccines. their access to compensation is up against obstacles. i do not have time to describe the necessary reform, please take a look at the statute of limitations of problems facing these families. heavy metals should not be injected into people, especially babies and young children and other people susceptible. this encompasses more than concerns about mercury. mercury is so highly toxic it is the big gorilla in the living room. in own tax0.6 micrograms to harm human tissue. it continues to be used in some vaccines including flu shots. that is a fact. it is damaging. it is also a fact that has been documented, replicated, and ignored. it is in front of gospel we pretend not to see. those in power have not listened and acted to protect the health and future of the children of this nation and instead have protected industry and government. my hope is for action. can we afford this continue inaction? thank you for listening and allow me to share my concerns. as a return to my iowa farm, i will reflect upon will my daughter and family have lost, and many other mothers and fathers whose hopes and dreams have been crushed with his chronic illness. we will continue to hope for action. our children and our future depends on you. >> think you're much, mrs. -- thank you very much, mrs. halverson. dr. dawson, i will start with you. you mentioned that virtually no comparative effective treatments for autism. this is something we have to focus on. we have to do the research. as mrs. halverson pointed out, we're in the here and now. families are struggling. we're facing this whole generation growing up and what is going to happen to them as adults. we have to focus on the most effective treatments we have now. this committee provided over $1 billion in the recent recovery act. dr. insel mentioned that earlier. $1.1 billion, up to be exact. if you cannot, we do not say exactly where to put them. but do know if any of those dollars will be spent on autism? ion included autism as one of the conditions that should be included. have you been watching or do you have any involvement in trying to see that some of these studies are done on early intervention programs? >> i am aware of the focus by the agency for health care equality on a comparative effectiveness. we have some recommendations in terms of the questions that need to be asked. i think it is so critical that parents have a sense of whether one thing is effective more than another treatment. the other aspect of comparative effectiveness has to do with method of service delivery. so we know now is that when children receive care, they often receive it by seven professionals who individual work with the child. the parents themselves have to act as the case coordinator. there are other models for how to work with a child with autism which involves a multi disciplinary team which has a financial aspect the coast to coordinating care. we feel this model is much more effective. that is another example of another study that needs to be done. look at different models of service delivery to find out what ultimately is most cost- effective. the other question has to do with the issue of personalized medicine. what kinds of treatments work for which kinds of individuals? we know that autism is not going to be a one size fits all kind of treatment approach. so we need to understand the effectiveness of understanding the underlying bio markers whether we're looking at medical conditions or genetic conditions, metabolic conditions and how these can direct treatment approaches. we are at a very early stage in understanding the question of which treatment worked best for which individuals. until we do that, parents go on to the internet, they seek out answers themselves, and often act on non evidence-based decisions. >> pepper rings me to mr. thompso -- that brings me to mr. cobbs. i got interested in a tele-help using some time ago. we are in a rural state and we don't have a lot of access that people in urban areas have. i became more interested and more tunes in on the issue of autism a few years ago. a lot of families that have young children that are diagnosed with autism, they do not know what to do. there are some residential programs for older kids come up for a transitional things. correct me if i'm wrong. you can jump in on this, too. i think there is some pretty good evidence that the earlier you get to these kids and provide them with supportive services, interventions by trained people that know what they're doing, that there really do get over a lot of these things. they get over the problems they have had. the earlier you get to them, the more effective if it is. how did you get to them early if they're living in oxford, mississippi, or someplace like that? so we have some money in this project, of looking at tele- help and how you can get together with a group of professionals early on and then with high-speed internet. it's like you are right there. you get that 24/7. you have been on this -- you have been in this experimental program for three years. >> we have continued the studies so we contest the longevity and to show the program can grow with the child. >> have you talked to other people? you're the chairman of the iowa autism council. i just know about you. have you talked to them about this? >> that is a great question. just this morning we were talking. is an aha moment. it is the light bulb that goes off. if noah is having a great behavior day, we can replicate them. we can start to build on that with applied behavior analysis. if he is having a bad day, it is not because we are in a physician's office. it is because he is in his own home and something has triggered that behavior. immediate response to track down what is causing the behavior. we can get immediate results. both good and bad. >> the other thing the economic thinking about this, kids with autism, they do not act up or anything went there of the doctor's office. but then you get home and they do. >> in our case, it might be the exact opposite. the informant of a doctor's office could have to much stimulus. you could get the reverse affect. all of a sudden, we have a behavior taking place. therefore, we may have to leave that in farm without properly getting the care. it is a great adjunct peace to a great program. it is also a great way to bring a comprehensive seen together to treat the child in a natural environment. >> are we doing in the studies to show the comparative effectiveness? or is this something that hopefully, this $1 billion put in there will start to take a look at the. does anybody know that? >> not with respect to the tele- help program that i'm aware of. >> we just completed the tele- help large study. the good news is the recovery act has given us this opportunity to open up the doors for additional work. n we do have some exciting proposals on tele-help for autism specifically that we are hoping we will be able to fund. i think this is the chance to see real progress in this arena. it is not only for the child. this is for the family. that is where some of the big applications will be. >> miss halverson, i am assuming you're not on this tele-help. >> no. we have hit all aspects. we found out about it biomedical site first and then from a out aboutba. we have used both. -- and then found out about aba. i know a lot of families agree with me. if your child does have these biomedical issues, you are going to get better results using the aba. >> how would you feel as a parent if you access in your own home with your child 24/77 anything that happens with your child, you would have ready access to trained specialists. you would be in constant contact with them. >> it was not as much of an issue. for me, and the medical care she needs, i can only obtain in a doctor's office. if i'm taking her in -- she has been undergoing intravenous therapy. that is an infusion in their doctor's office. then we do circulation on top of that. that has to be done no matter what. >> i see the difference. i have taken 10 minutes of time. senator cochran. >> thank you. i appreciate you coming to the hearing. as a committee, which tried to tailor programs of support, research that are needed that will help make positive contributions to solving the problems that you face personally or professionally. is there something that any of you have in mind to suggest -- i know miss halverson talk about financial support and to figure out ways to be more supportive, tangible benefits of some kind, insurance programs that may be the government can help support in terms of cost or premiums or sharing responsibility. it seems to me we have a lot of organic medical disabilities that come within the theambit at of insurance that this insurance is not being helped with. a wonder if you have any thoughts all along those lines. >> i would like to comment on this notion of early intervention and tell you about the study dr. insel was talking about. this was a study were children began the intervention below 30 months of age. it has been conducted with toddlers with autism. the children work randomized into either standard care in the community or and intensive intervention that focus not only on working directly with the child but also talk of the family how to use intervention strategies so that intervention occurred wiwith the child. it was approximately 25 hours a week of structured intervention. all the tests were done blind. at the beginning, both groups of toddlers with autism had aciq's in the mentally retarded range. their iq increased to the extent that they were no longer in the medically retarded range. they have better language. many children when from autism to pervasive developmental disorder, a less severe diagnosis. this a two only years and the children were 4 only. it should continue for another year or two. so we know they are in effective. we do not two have things that limit access. financial support for families. this is essential. it will save us money. it will help families and it will allow individuals to take revenge of some of the programs we have heard about. the second piece is a training for professionals and for parents. many of the interventions that we're developing now are actually teaching of the parent to deveo teach the intervention. they are in normal settings. we need programs such as medicine and we're developing training programs that we're using to train parents and professionals in the united states and around the world. we're working in india and africa and other developing countries to train professionals. insurance coverage and trading professionals will be absolutely key. then we will get kids on the right trajectory. we need to look to see how we can continue to support people with autism is to become the best citizens they can. >> thank you very much. that is interesting analysis. mr. iss boyd. >> the task force looked at this in mississippi extensively because of the financial situation of many of our parents. they presently do not cover those services. it is out there federally. it needs to now include behavioral services. many of these children are starting to be identified early. i can speak to the success of that. we were in san antonio this summer. i met a child named catalina. she began behavioral therapy. this child is 04 years old and is absolutely amazing. you would never recognize that she was a child with the spectrum. i saw that working. the other program that has to be looked at is medicaid. states have an option of whether they can give a waiver. i would encourage you to look at that. it is one of the things that could reach out to these families who do not have the finances to do that. the other thing that dr. dawson mentioned is private insurance. there are virtually almost no policies in our state the cover autism therapies. there are none. it does not cover behavioral therapy, and it only covers 20 visits of any type of speech or pt. usually by the first six weeks of the year, you have run through your insurance coverage for your child. that is combined speech and ot. you can see what many of these children are not getting the assistance they need. the visits are costly. those are the things we look at, gaps that needed to be filled in the system. >> i think we should introduce a bill to modernize our laws on medicaid and reimbursement. >> how to people afford to do this? >> they cannot. >> frankly, they cannot. i know we have been working to get insurance in virginia. a number of states have mandated insurance coverage. it is a fox fall by fox will fight. in virginia, the average income is about $50,000. the average cost of services is about $85,000. the families have to do without. it's been done by state-by-state basis. how you can do some kind of insurance pre-emption would be an ideal way to go. this is an educational issue. it is not a health issue. if you see in two sons, it is a combination problem. >> the other factor that didn't get brought up is the financial stress and what it leads to. the divorce rates and we see this anecdotally. it is a minimum and around 80%. there is some estimate -- a speaker from california in the group of people she counseled, and her divorce rates were 90%. these are incredible numbers. in mississippi and our region, which two lost parents this year who could no longer handle the stressors of having a child in the program. one was a friend of ours. that is not unique to mississippi. that is things we foresee all around the country. >> thank you. >> i would like to go ahead and piggyback on that statement. the government needs to move rapidly to go ahead and advance great technology is such a tele- help technology. it is easy to go ahead and pass a bill here or there. in order to make change, we have to have standards and the reimbursement model for applied behavioral analysis and other proven therapies. it is recommended by the surgeon general. private insurance companies typically do not reimburse that for families with autism. >> we do have a unique opportunity with health care reform to address this issue. the house bill does include coverage for behavioral intervention, for autism, as well as aba. i think it is critical that with this opportunity that we are looking at in terms of health care reform that we include this. the payoff in terms of the financial payoff down the road, it is going to be tremendous and will help with the tsunami. the impact on the families will also be tremendous. it is an opportunity we must not miss for these treatments that we know work and are cost effective. >> we are going to introduce something together. [laughter] we will iron out the details later. >> if i cannot edit from the iacc perspective, as well as someone who has been reading the charts along with the president of the autism society of america. together they have been listening to families about these issues trying to come up with some recommendations. if we can be helpful, i am sure that group would love to have an audience to give you some ideas. >> thank you. you just mentioned standards. someone mentioned about how you go on the internet and get all kinds of misinformation. you have been on this tele-help for three years now. you're dealing with trained professionals that you work with. you mentioned standards. but talking about setting up those kinds of standards? >> absolutely. it was a comprehensive treatment program that first started with a face-to-face interaction. from this can pretty much pawpaw any internet search and tiepin "tele-help" treatment and their first contacts video to video which i do not think it is possible to form a pure therapeutic bond and to get to know the child to treat the child. it is disconcerting. ms. dawson touched on this. you'll get a myriad of different treatments, kind of scattered among to things like car advice or things like saying, i will paint your house. it is so sporadic. parents still have a consistent place to make sure they receive consistent quality of care. i encourage you of folks meeting and talking about new treatments. until we get a set of parameters for standards so when parents get treatment, especially over innovative technology, they have the insuranassurance that they l get a trained person. right now they are not there. >> i just wanted to mention a program that is a wonderful example of a public-private partnership that is beginning to address this issue of standards. is the autism treatment network. this is built on the cystic fibrosis model. it was in the same situation of not getting quality care, no standards for how child should be treated. and so the way in which this model works is it is 15 hospitals that care for children with autism that have come together to both look at quality of care, models of care, as was to develop standards but that can be practiced standards published in journals that physicians can then guide things like assessments, behavioral interventions, and so forth. so there is no mechanism where this is beginning to be addressed. it is in the early stages. it is funded by autism speaks. >> who works on these? i asked my staff. who is charged the responsibility of coming up with standards that have to be met so we do not have people out there that do not know what they're doing? >> you stumbled onto an interesting issue. it is not unique to autism. we built standards around by a medical interventions that are essentially overseen by the fda. in the broad intervention arena of whichab aba would be part of that, there's not a licensing body that oversees this in quite the same way. it is a gap. the question is, even in this health care reform discussion, when you're talking about treatments that may not be given in a doctor's office or in one of the 15 hospitals that in falls families to the minister care, 10, 15 hours a week, how does that get reimbursed and how do we set standards for the degree of care and the level of care that is needed to be reimbursed? >> was that rhetorical? [laughter] i cannot answer that question now. >> i am a psychiatrist. [laughter] >> asking probing -- [laughter] >> that is true. well, again, obviously we have a whole range of interest here and everything from their research into the causes. obviously, there is a lot of talking about vaccines. we had some questions about it. about the number of vaccines and how we set up that kind of a study that ms. boyd -- i think it was misspellms. halverson. i just do not know how to do it. you can see your kids are not getting immunizations because we will put them on a study. if you wanted to determine that, i do not know how you go about doing that. >> one of the reasons i wanted to bring that up, mr. harkin, there are so many families right now, and this greatly concerns me. i'm a vaccine proponent. i believe and vaccines. i believe there are a great public health achievement that we have ever had. i am a huge proponent of it. what i am concerned about, there are so many families right now that are not vaccinate their children. we do vaccinate our children. there are so many that are not vaccinating right now because of what they perceive as a huge risk. and so i am concerned that n theih and the cdc -- the nih and the cdc and people may have some interest into this. they are doing more harm to lower the heard immunization rates than anybody that is spilling out there to be concerned about vaccines. there are so many people right now they're choosing not to vaccinate their children. i don't think the population is going to be as difficult as scientists perceive that it is. within the autism community, we see that going in right now. and that concerns many of us who feel vaccines are very important because -- we hear from was all the time come up to us and say, we're not going to vaccinate our kids. having a husband as a medical professional, i work as an attorney in public health. it really concerns me. many of these families that say they will not vaccinate their kids do not have any of the possible health care characteristics that some of us who did have children had the could've been red flags. they could have been studied. i think that the scientific community can find those people to do that. >> dr. insel. miss halverson. punch the button. >> i do not know how many people you're thinking will need to be included in the study. there is a physician in the chicago area that has a practice of about 35,000 patients and many of them choose not to vaccinate, and their offices and rage is next to nothing. there are populations of people -- and the rate -- the autism rate is next to nothing. the population with this doctor is very broad based. it is not people from every walk of life. >> i do not know about that. >> let me just be very clear. i am representing what we know about the scientific evidence so far. that is unequivocal. it is a not thecd cdc and nih. multiple studies have looked at this. this has been looked at over and over again. 16 large-scale studies have looked at this. whether you read the studies or listen to the institute of medicine -- >> looking at the connection, the possibility of a connection between the vaccination with without a particular formulation can be prevalence of autism. whether this is a risk factor. the studies have found no evidence of a connection. we heard that. the looked at the whole broad spectrum and we heard from the injury cord. they said there is not plausibility here. >> i mentioned getting a study done of the number of vaccines, the number of vaccines in the first two years of life compared to what was 20 or 30 years ago. can we compare the incidence of autism among children 0 to 2, compared to a case that got five or six or seven or eight, what they did in 1980 to compared to29. i do not know of any studies. there are no studies that have done that. >> if you're asking the question, has the prevalence of autism increased over a time when the number of vaccines has increase, is there a relationship? we know they're both going up. we do not know it is, is there any causal relationship between the number of vaccines that are given. 29 of two over years. in 1980 it was eight or nine, or whatever i said. i have the figures from cdc. is there any causal relationship from the number of vaccines, 29 in two years, and higher incidence of autism. we do not know that. there are no studies. >> the way to do such a study would be to -- we would have to >> the way to do such a study would be to -- we would have to

Transcripts For CSPAN Tonight From Washington 20090806

healthcare, so seized your jicama their families in afghan or iraq or talk about how they are going to get jobs. host: thank you for joining us. guest: you have the nicest location on capitol hill. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] . >> dissent continues to debate on the nomination of sonia sotomayor. you can see a tally of house senators say they will vote. coming this fall, tour the home to america's highest court, "the supreme court." >> two journalist are right tom today. they were accompanied by president bill clinton who helped secure their release. they were for -- that were from al gore's current tv network. >> welcome home laura ling and euna lee. [applause] [inaudible] [inaudible] [inaudible] [inaudible] [laughter] >> 30 an hour seco -- 38 hours ago, euna lee and i were prisoners in north korea. we appeared at any moment that we could be sent to a hard labor camp. and then suddenly we were told that we were going to a meeting. we were taken to a location and when we walked in -- through the doors, we saw standing before us president bill clinton. we were shocked. but we knew instantly in our hearts that the nightmare of our life was finally coming to an end, and now we stand here and on and free -- home and free. euna and i would like to express our deepest gratitude to president clinton and his wonderful, amazing, not to mention supercool team, including john but as the -- podesta and the united states secret service, who traveled halfway around the world to secure our release. we would also like to thank president obama, secretary clinton, vice-president gore, who we also call al, the swedish ambassador, and the people at the u.s. state department who worked so hard to win the release of their fellow americans. steve bing and his crew, and the dow company, and i know that i am for getting a bunch of instrumental people right now, and for with me if i am totally incoherent. -- and forgive me if i am totally incoherent. to our loved ones and to the complete strangers with the kindness of heart, who showed us so much love and send us so many positive thoughts and energy, we thank you. we could feel your love all the way in north korea. it is what kept us going in the darkest of hours. it is what sustained our fate that we would come home -- our faith that we would come home. the past 140 days had been the most difficult, heart wrenching time in our life. we are very grateful that we were granted amnesty by the government of north korea, and we're so happy to be home. we are just so anxious right now to be able to spend quiet private time, getting reacquainted with our family. thank you so much. >> ladies and gentlemen, the families asked me to say a few words, and on their behalf all of us -- and on behalf of the staff and families of current tv and mike cofounder, we want to welcome laura and euna home. we will not think president clinton for performing this so skillfully and four members of this team who played a key role in it. and also to president obama, laura mae agendas, but he has been deeply involved in this humanitarian effort. to secretary clinton and members of the state department, several of whom are here, they have really put their hearts into this. it speaks well of our country that went to american citizens are in harm's way -- that when two american citizens are in harm's way, people would go to work and make sure that this has had a happy ending. we're so grateful to all of them. to the thousands upon thousands of people who upheld loran and duna in their prayers, who called in sick e-mails, we were very grateful. to steve bing and all the folks who have made the flight possible, we say a word of thanks -- deep banks as well. -- deep thanks as well. i want you ought to know that your families had been unbelievable, unbelievable. passionate, involved, and you'll hear a lot of stories. they are looking bored to hearing all lot of stories from you, but euna, hannah has been a great girl why you have been gone. and laura, your mother has been making your special soup for two days now. for everyone who played a part in this, and especially thanks to president bill clinton, my partner and friend, so grateful. and ladies and gentlemen, thank you for coming out. we're going to let these families at a full and proper reunion now, but thank you for coming out. >> on his way to indiana today to make a speech on the economy, president obama talked about the two journalist from north korea. >> good morning, everybody. all want to just make it brief comment about the fact that the two young journalists, euna lee and laura ling, are safely back with their families. we are obviously extraordinary relieved. i had an opportunity to speak with the families yesterday once we knew that they were on the plane. the reunion that we have all seen on television, i think, is a source of happiness, not only for the families but for the entire country. i want to thank president bill clinton. i have a chance to talk to him for the extraordinary humanitarian effort that resulted in the release of the two journalist. of what the bank vice-president al gore who worked tirelessly -- i want to thank vice-president al gore who worked tirelessly to achieve a positive outcome. i think that not only is this white house obviously extraordinarily happening -- happy, but all americans should be grateful to former president clinton and vice president gore for their extraordinary work. my hope is that the families that have been reunited can enjoy the next several days and weeks' understanding that because of the efforts of president clinton and gore, they are able to be with each other once again. we are very pleased with the outcome, and i am hopeful that the families are going to be able to get some good time together in the next few days. thank you very tibet -- thank you very much. >> while in indiana, president obama announced that the government will provide $2.4 billion to this factor. it is part of a speech of an economy that took place in an rv manufacturing plant. this is about 30 minutes. >> thank you very much. thank you. thank you so much. thank you. please, everybody, have a seat. thank you so much. well, it is wonderful to be here. thank you so much for the wonderful welcome. urban, thanks for the great introduction. it is great to be back in indiana. [applause] this is as close as i have gotten to home in a while. and i flew out here with somebody bill i think the people of indiana have known for a long time and have trusted for a long time because he is fighting for working families each and every day, our great senator, and i -- evan bayh. please get them around of applause. -- please gb him of round of applause. too often there are those in washington to focus on the ups and downs of politics. my concern is the ups and downs in the lives of the american people. the families feeling the pain of this recession, the folks i have met across this country, who lost jobs, savings, and health insurance but have not lost hope. the men and women who still believe in the capacity, the ability of this nation to meet the challenges of our times. these challenges you know all too well here. this area has been hit with a perfect storm of economic troubles. over the last few decades, you have borne the brunt of a steadily weakening american manufacturing -- in the face of global competition. you have felt the struggle of the global auto industry, and the repercussions that have hit the midwest especially hard. you are living every day but the consequences of this recession. and the financial meltdown, if you have felt that in all lost jobs and lost savings. as a result, the elkhart area has seen the second greatest rate of unemployment in the country, up 10 points in a year. it is astonishing. there have been times when nearly one in five people in this area have been looking for work. you have seen factories closed and your sons and daughters move away in search of jobs and opportunity. this is more than an economic crisis. this goes to the heart and soul of the community, it tests the strength of families and the spirit of good people, hard- working folks who read given them all -- who have given their all. there are some that have seen what is taking place and had suggested that it is all an inevitable. the only way to get ahead in his for elkhart to be left behind. you hear that sometime in washington. you know and i know that the truth is exactly the opposite. i am here because i believe our ability to recover and prosper as a nation depends on what happens in communities just like this one. [applause] the battle for america's future will be fought and won in places like elkhart, detroit, goshen, pittsburg, south bend, youngstown, and cities and towns across indiana and the midwest and across the country that had been the backbone of america. it will be won by making places like elkhart what they once were and what they can be again, centers of innovation and entrepreneurship and opportunity. the puzzling humming engines of american prosperity. boras the world grows more competitive, we cannot afford to run the race at half speed. if we want to leave this century like we left the last century, we have to create the conditions and opportunities for places like elkhart to succeed. we have to harness the potential, the innovative and creative spirit that is waiting to be awakened all across america. that is how we will rebuild this economy stronger than before, strong enough to compete in a global economy, to avoid the cycles of boom and bust, strong enough to support the jobs of the 21st century, and strong enough to unleash prosperity for everybody, not just some. but before we can rebuild our communities, we have to rescue it today. that is why we passed our recovery act less than one month than we did -- when i got in office. we did so without any of the earmarks usually from washington. there have been a lot of disinformation out there about the recovery act. let me tell you what he is and what it is not. the plan was divided into three parts. 33% of the money has gone to tax relief for families and small businesses. 33% is cutting people's taxes. for americans struggling to pay rising bills or shrinking wages, we kept the campaign promise to put a middle-class tax cut into the pockets of 95% of working families. a tax cut -- [applause] a tax cut that began showing up in paychecks of 4.8 million indiana house holds about three months ago. we also cut taxes for small businesses, on the investments that they make, and more than 425 small businesses in indiana have received lsba loans for the recovery act. another 33% of the money in the recovery act have been for emergency relief who have borne the brunt of this recession. for americans who were laid off, we expanded unemployment benefits, and that has already made a difference for 12 million americans, including 220,000 folks right here in indiana. we're making health-insurance 65% cheaper for families relying on cobra wall looking for work. some already know people who have lost their job worried about their health care, not able to afford coverage. we reduce their costs by 65% said that to keep their health care while they were looking for jobs. and we have provided assistance that has saved the jobs of tens of thousands of teachers and police officers and other public servants, so that you would not see the recession get any even -- get even worse. the first that is tax relief, the second part is for small businesses and that individuals that have fallen on hard times predella last 33% of the recovery act is what we're going to talk about today. investments that are not only putting people back to work in the short term, but laying a new foundation for growth and prosperity in the long run. these are the jobs that are building the future of america, upgrading our roads and bridges, renovating our schools and our colleges. the elkhart area has seen the benefits. they have resurfaced the runway of elkhart airport. u.s. 33, part of the city health center has received recovery dollars. it is hired additional staff. and as part of the recovery plan, we're making an historic commitment to renovation. the recovery act creates jobs, doubling our capacity to regenerate renewable energy, building a new smart bread, take -- carrying electricity from coast to can, laying down the broadband lines, and providing the largest boost in basic research in history to ensure that america leads and a breakthrough discoveries of the new century. just as we led in the last. because that is what we do best in america, we turn ideas and inventions into industries. history should be our guide. the united states led the world economy in the 20th-century because we lead the world in innovation. today the competition is keen ear, the challenges tougher, and that is why innovation is more important than ever. that is the key to good, new jobs in the 21st century. that is how we will ensure that the high quality of life for this generation and future generations. we are planting the seeds of progress for our country and good pay in private-sector jobs for the american people. that is why i am here today. i am announcing $2.4 billion in highly competitive grants to develop the next generation of fuel-efficient cars and trucks powered by the next generation of technology is all made right here in the u. s. of a. right here in america. [applause] made in america. you know, for too long we failed to invest in this kind of innovative work. even as countries as china and japan were racing ahead, and that is why this announcement is all-important. this represents the largest investment in this kind of technology in american history. see, i am committed to a strategy that ensures that america leads in the design and implement of the next generation of clean energy vehicles. this is not just an investment to produce in -- vehicles today, testing and developing technologies tomorrow, creating the infrastructure of innovation. indiana is the second-largest recipient of grant funding and it is a perfect example of what this means. you have purdue and other name, all receiving a grant funding for these projects. that is number one. we've got a small business in indianapolis that will develop batteries for hybrid and electric vehicles. you have allison transmission in indianapolis, and other companies, all who will help develop electric components for commercial and passenger vehicles. and right here in elkhart county, navastar and other facilities will receive eight $39 million grant to build 400 advanced battery trucks with a range of 100 miles. [applause] right there. just a few months ago, the spot that these factors might be closed for good. now they're coming back to life. you're welcome. thank the american people. the company estimates that this investment will help create or save hundreds of jobs in the area, and already boxlike herman are being required -- folks like herman are being retired. this will save or create thousands of future jobs -- of hoosier jobs. this would not be possible if not earlier this in congress who supported this, leaders like evan bayh and brad ellsworth, and peter, and these grants will create tens of thousands of jobs all across america. in fact, today vice-president biden is announcing grant winners in michigan. members of my cabinet are fanning out across the country announcing recipients elsewhere. we're providing the incentives to those businesses large and small that stand ready to help us lead a new clean energy economy by developing new technologies for new types of vehicles. i do not want to reduce our dependence on foreign oil and then end up being dependent on their foreign innovations. i don't have to it in part of a hybrid car, i want to build a hybrid car here. i want to import a hybrid truck, i want to build a hybrid truck here. idolater import of windmill from someplace else, i want to build a windmill right here in indiana. i want the cars of the future, that technologies that power it, to be developed and deployed right here in america. and that is just the beginning. in no area will innovation be more important than in the ways to produce new energy. we are not only doubling our capacity to generate renewable energy and build a smarter electricity grid, we have reached an agreement to raise fuel economy standards. we created a system of clean energy incentives which will help make renewable energy the profitable kind of energy in america while helping end our dependence on foreign oil and protecting our planet from future generations. we are now working to pass the legislation through the senate. we know that the real innovations depend on government but on the generous potential of the american people. if the american people get a clear set of roles, if they know what is needed, what challenges we have got to meet, they will figure out how to do it. that is why our budget makes this research tax credit permanent. it helps companies afford what are sometimes very high cost in developing new ideas and new products. that means new jobs. this tax credit returns to dollars to the economy for every $1 that we spend. for a long time, we were trying to renew it once a year and companies did not know whether they could get the next year. that has changed. we have now made it permanent. i also proposed reducing to $0 the capital gains tax for investment in small businesses, because they are innovative businesses, producing 13 times more patents for employees than large companies. of course, in order to lead in the global economy and ensure that our businesses can grow and innovate, we have to pass health insurance reform that brings down costs. [applause] reform that brings down costs and provides more security for people who have health insurance and more affordable options for those who do not. i promise you, we will pass reform by the end of this year because the american people need it. the american people need some relief. we're going to have to make it happen. in fact, the recovery plan began the process of reform by modernizing our health care infrastructure. we took some long-overdue steps of computerizing the health records which can reduce all but waste and heiress that cost millions of dollars and thousands of lives while protecting patient privacy. it is also important to note that these records all the potential offering patients the care chance to be more active participant in the prevention of diseases. you will not have developed the same form of a dozen times. you will not have to rely on your memory when talking to your doctor. they also reduce our costs and lower your premiums and give you more security in your health care. now in addition to energy and health care, we also note that a nation that out-educates us today will now compete us tomorrow. we are making a historic commitment to increasing education. our schools continue to trail many of our competitors. i have challenged states to dramatically improve achievement by raising standards and modernizing science labs, upgrading curriculum, forming new partnerships to promote math and science, improving the use of technology in the classroom. and i have set this goal -- in the next decade, by 2020, america will once again have the highest proportion college graduates in the world. we do is to be number one. we will be number one again when it comes to college graduates. [applause] net to reach this goal, we have provided tax credits and grants to make college education more affordable. and we have made a historic commitment to community colleges, which are the unsung heroes of america's education system. america can and must have the best educated, the highest skilled work force in the world, because we are building new cars here in america. if we are building a new clean energy grid in america, then we will need to build engineers in america, and scientists and america, and skilled technicians right here in america. so all of these pieces are fitting together. energy and innovation, health care and education. these are the pillars of the new foundation that we have to build. this is how we want just rescue the economy, but we're going to rebuild it stronger than before. there are a lot of people out there who are looking to defend the status quo. there are those who want to seek political and bandages -- advantage, they want to oppose these efforts, because these problems in the first place and now they do not want to be distracted -- they did not want to be constructed, they just wanted to the usual political fights back and forth. and that is fedy ball the cable chatter on the media. but you and i know the truth. we know that even in the hardest times, against the toughest odds, we have never surrendered. we do not give up. we don't surrender our dates to chance. we have always endured. we have worked hard and we have fought for our future. our parents had a fight for their future, our grandparents had a fight for their future -- that is the tradition of america. this country was not built by griping and complaining. it was built by hard work and taking risks. [applause] and that is what we have to do today. so i know these are tough times. if you have not lost a job, you know somebody who has, maybe a family may burke -- a family member, a neighbor, a friend. you know that ias difficult as losing a job in the, it is more than a paycheck. we define ourselves by the work that we do. a sense that you are contributing and supporting your family and doing the right thing and you are responsible. the truth is, it can be easy to lose hope. especially when you see a lot of folks out there who fail to meet their responsibilities, on wall street to washington -- it can be easy to grow cynical when ec politicians say one thing and then to another, or say one thing and then do nothing. when u.s. seen decades of broken promises and broken policies. but this is a rare moment in which we are called upon to rise above the failures of the past and a chance to restore that spirit of optimism and opportunity which is -- which has been central to our success. we have to set our sights higher, not lower. we have to build a future where new american cars are powered by new american innovation, a brighter future for elkhart and for indiana and for the united states of america. that is what we are fighting for. that is what this plant is about. that is what you are about. that is what we're going to achieve in the weeks and months to come. so thank you very much, everybody. not unless the united states of america. thank you. -- geode the blasts -- god bless the united states of america. thank you. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] [military march playing] ["stars and stripes forever" playing] ["stars and stripes forever" playing] [military march playing] [applause] >> we just heard president obama talking about health care and the economy. in this quinnipiac ball, americans are worried about the deficit but they approve of general pieces of the bill. here is more about that survey with quinnipiac assistant director peter brown. this is about 20 minutes. >> i am here to deal with the latest quinnipiac poll which deals with health care. this is the largest university in the state of connecticut and does public opinion polling as a public service on national and state issues. what is interesting about this poll in a political sense is that we're seeing something that we rarely have seen in recent american political history, which is that the budget deficit is becoming a big deal to average voters. over the last several decades kattegat's and organizations have tried to use it don't mobilize political support and win elections, and frankly, it has not been very effective. ross perot tried in the 1990's and he finished third. you made me remember 1984, walter mondale campaign on the need for a tax increase to help solve the deficit. he carried only his own state. what we're seeing in this poll is substantial public concern about the deficit, so much so that the majorities are even willing to throw health care reform overboard if they think it will add to the deficit. for instance, by 55% to 35% margin, voters say they are more concerned than health care reform -- that health care reform will add to the deficit than that candor -- been that congress will not enact health care reform. by 57%-32% margin, voters said that they would rather have no health care reform than a health care reform that add substantially to the deficit. also, another interesting fact -- if you ask voters if yet -- it they would support the bill if it had only democratic support, a 59% stake know. president obama, who as we all know, as high job approval ratings on a number of issues during his first several months of office, but 52% give him a thumbs down job approval on this issue. that is substantially different from july, the last time that quinnipiac asked this question, when 47% approved of him and 47% disapproved of him. one other common aside for the president on health care and public opinion, almost 70% say that they do not believe that obama can produce a health care reform package or bill that will not add to the deficit. the president says that he will be able to do that. obviously voters are becoming skeptical. another interesting piece of data in the survey is that by and large -- not by and large, but more voters think it will not help the quality of their health care than think it will. this is not all good news for the president. more than 60% of voters still support having what is called the public option, but the number has decreased five points over the last month. and the vast majority of americans prefer to get their health insurance rather -- from a private insurer. much of the change in public opinion and the reason why the president's numbers are down and support for some of these programs are down are independent voters, those who broke strongly for president obama last november and in the early months of his administration have been very supportive of him and his policies. now the majority'ies are voting the other way or are indicating that they are less supportive of the president. i will be happy to take your questions. yes. >> you point out in question #30 that the president has said he will not sign a bill that is not paid for. the house and the senate proposals supposedly are fully offset. so why this reaction? it looks like people do not believe the government anymore. >> that is a fair analysis. yes, people obviously -- obviously those of us in this room, a journalist to cover politics or policy or public opinion, by and large, they may have a different frame of reference and the average voter. the average voter out there has always been skeptical about government. some have interpreted president obama's election as a mandate for larger government, and that may or may not be true. what is clearly showing here is there is a lot of skepticism about public officials that still remains. >> of the republicans in congress having as of that? >> to some degree, it is due to republicans raising issues that made voters uncomfortable. those republicans and blue dog democrats who had been very public about their worries about the increasing deficit in the health care reform bill, might just increase the deficit dramatically. it is obviously had an effect on the public. they have heard estimates of numbers that are very large, potentially hundreds of trillions of dollars over decades of war dead. and again, it is worth pointing out this concern about the deficit is really very unusual in recent american history. it is something that has been given lip service. this is just a poll, so there is a difference. but what we see here clearly is that voters are concerned about the deficit. the question of which 57% say they would rather have no plan been one that increases the deficit is start in terms of what people want. what will happen over the next month, as we all know, is that the republicans and democrats will spend an awful lot of money when they go on to see their constituents and television ads and the interest groups that support them, telling voters i did a good part of the plan or the bad part of the plan, depending on the perspective. and we will know when a mother so whether they can change public opinion one way or the other. it is a fair analysis but the momentum that president obama enjoyed on health care reform with the country being behind him has slowed and perhaps stopped. that does not mean it will not start up again. let's be very clear about this. polls are snapshots in time. but there clearly more concerned about not increasing the deficit than having health care parent. that is an indication that the momentum that he gained office with has been slowed substantially. >> the republican message of this is adding to the deficit is working. is there anything that you would advise democrats to do in august, something that they should be pounding on? >> they need to reverse the number that says that almost 75% to not think that he can sign a health care plan that will not increase the deficit. if people do not believe that the president and our congressional leadership, that what they finally come up with will not increase the red ink. that is really the key to it. there is a gigantic battle that will go on over the next month or so. it will not be -- it will be in dayton and denver and detroit and any place out where the americans are, not in the beltway. what lawmakers find when they go home will determine likely what happens to this proposal, and therefore, what public opinion tells these lawmakers as they go home is critical. [inaudible] not necessarily. >> the republicans in congress? >> that is clearly true. we asked to do a better job, president obama for the republicans in congress. the president had a 10-point lead. that is good for the president but here is that that is. a month ago, he had a 20-point lead. it is in your package there. that is another reflection of the momentum slowing and perhaps turning. now he is still -- a number of the aspects of the plans that have been tossed around have shrunk support. boaters' think that there should be a public option. they may not want for themselves but that think that there should be a public option. they like the idea of taxing business and the rich. they do not like the idea of taxing themselves for taxes on health care benefits. they support subsidies for large groups of americans, and the poll finds strong support subsidies for individuals and families of four that make up 88,000 a year. those are large birds of americans for subsidies. the median family income is more than $50,000. it is slightly more than $50,000. americans back the subsidies. with one hand, they think government is a good thing. on the other evening -- on the other hand, they are skeptical of the deficit rising. maybe this is not surprising. this is what happens in politics. people always want to know what is in it for me. what is interesting in nasdaq is that voters are concerned -- many voters are concerned. 85% of the electorate has health care. many butters are concerned that this will help other people but not help them -- many voters are concerned that this will help other people but not help them. >> you point out here that -- they want businesses to pay for it, they want the rich to pay for it. they do not want to pay for it. are they really worried about the deficit? >> as i said, public opinion is inconsistent. there is nothing new about that. you can go back to public opinion before. they do not want their taxes to go up. we gave them a choice between no health care plan and a larger deficit or a health care plan that would substantially increase the deficit. they do not like that. that is interesting. again, it is hard over emphasize just how big a deal it is that that deficit means something to people. it really has not in the last several decades. when ronald reagan got elected, they thought they could do it by cutting waste, fraud, and abuse. the most successful politician in recent american history. yes, ma'am? >> this is the people actually support the main parts of the plan. the poll results indicate on missing -- and messaging success? >> right. i am not sure that is messaging. my guess is that if we asked americans to finance anything, they would be much more likely to say, let's tax business and the wealthy as opposed to the middle class. we could probably be talking about iwidgets here. they would have that those priorities. that is just human nature. >> apparently a lot of the messaging during the august break, from what we have heard from the speaker in the past two essays in the president himself will be about the insurance industry, the public plan, support supposedly -- other polls have shown support for the public plan. >> yes. >> says they have come out and said it at that will be their focus over the break, you are saying based on what you see here is that the key to it -- your words -- is focusing on the deficit and making people believe you when this is not going to add to the deficit. you think that is a misuse of their time and energy to try to generate support for the public plan, attacking the insurance industry? >> i am a pollster, not a political strategist. these numbers show that the voters are very concerned about the deficit. that is not to say that political hay cannot be made by hitting the bill hard. but the mothers are very concerned about the deficit, much more, again -- the recent political history is one where the deficit gets lit service and does not matter. these numbers show that it seems to be battery. that is really different. -- it seems to be smattering. that is really different. . these numbers indicate that the deficit matters the least to the people who led been taken away from supporting the plan. >> do you have any insights, the tipping point was? >> there has been a change that is set in stone. this poll but was taken -- that was taken -- it may just be the numbers being tossed around. trillion's is a big number. it also comes a time when job approval overall is coming down. it may be a melting of a number of things. it certainly does not help the president of unemployment keeps going up. the frustration of voters have with the economy obviously has the effect on how voters feel about any economic issue and health care certainly is an economic issue. >> i do not see it in this poll, but in other places you've looked at how the impact of the economic stimulus package and how that as to the budget -- >> we ask about the economic stimulus package. it was not asked about the context of this. >> to know what is my due to president obama or the democrats? >> if the numbers keep coming down, that is not good for the president or democratic party. polls are snapshot in time. they do not tell you what will happen in the future. the trend is not one that makes the folks in on pennsylvania avenue happy. >> to think people will be less healthy -- happy with -- you think people would be less happy with the health care reform? >> we did not ask this question. during that time, it showed a the the president. -- it showed faith in the president. what we are seeing here, the '70s sermon to nothing you consign health care reform even though he is -- the 70% that say you cannot assign healthcare reform, that doubt is it operated. -- is evaporated. thank you. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> a federal jury today convicted former louisiana congressman william jefferson of racketeering and money laundering. he represented parts of new orleans and was accused of accepting more than $400,000 in bribes. you'll hear from the prosecution and the defense attorney outside the courthouse in alexandria, va. >> i want to begin by thanking the prosecutors in this case in. i think it is important to note the importance of this prosecution in that congressman jefferson had come back to the citizens of louisiana and the people of the united states. he showed them his services. he violated that trust and sold his office and that is what brought us here today. the citizens were owed honesty and integrity. he knew influence and power -- he used influence and power to enrich himself and his family. this case shows us that we are a nation of laws. no person is above the law. the prosecution was important from our perspective because public corruption is corrosive. the citizens need to have confidence in their government. when someone sells their offer, it replaces that confidence with cynicism. but $90,000 -- $90,000 is not a gray area. it is a violation. today the jury held him guilty. thank you. >> two years ago we stood here in front of you and talked about this unbelievable team of career prosecutors, agents, analysts, and they never gave up. they were relentless. today the jury confirmed their energy and professionalism. we also said the case was about power, greed, and money. the jury agreed with that. it show congressman jefferson that he sold his office and now he will face the price of that. the public needs to know that we are committed as an agency and department. i think they did a herculean job. they allowed every possible avenue of appeals. they went to the legal process. today they prevail. by a thank the jury for their -- i thank the jury for their work. he used his agreed to obtain money. he sold his office for the least common denominator of what public service is about and that is personal wealth and greed. to the public, you should be reassured that we will continue to place our emphasis not just in the new orleans or d.c., but across the country. >> could you give us your comments -- you worked on this for years. >> cannot comment. >> [unintelligible] >> and lots of things the why -- a lot of things the way into a think he is a flight risk. >> the words that were used as the some of these nations were cozy with him. the to overplay your hands? >> i do not think we overplayed our hand. we argued the fact that we saw this in the court and the court made a decision. >> what is the reason she was not called to the stand? >> there are many decisions made on how to present evidence and what goes on. there are sometimes hundreds and thousands of decisions. i will not get into an internal deliberation of why we did something or did not do something. as we analyze the case, the jury accepted it. >> [unintelligible] >> i think it is really difficult to speculate on why a jury reached the decision. we are pleased with the work they did. >> what about sentencing guidelines -- did you ask for the maximum all 11 counts? >> we will wait until we get a free sentence report. then we will study that. we will consider what we consider to be inappropriate sense. i'm not willing to speak for the than the right now. >> what you think the defining moment was for this case that led to the conviction? >> the defining moment of the trial? >> yes. >> i do not think it had a defining moment. i do not think most trusted. i think the jury reaches a collective decision between two people. that is why the system works so well. >> what you think is the most powerful evidence? >> out have to speculate on what the jury thought. willis got a powerful piece of evidence was the $90,000 -- we always thought a powerful piece of evidence was the $90,000. >> we finally got a chance to see the pictures is that something the play to the jury? >> i can only speculate what works for the jury. all this, there is definite evidence on a number of accounts. >> he is asking of the foreign corruption. >> the department has achieved many convictions with the foreign corrupt track. it has nearly become a cottage industry. in this case the jury did not accept it. >> he could face 20 years or more under sentencing guidelines. how complicated will be to calculate guidelines given the complex teams in shares of stock? >> the guidelines are advisory. it is not pitch for nearly complicated. -- extraordinarily complicated. >> thank you you all. >> what was your reaction to the news today? >> a la the people said there will be an honorable explanation. >> they did not accept a deal that counts. that was the evidence. it was a week on that. -- it was weak on that. >> the prosecution has tried to paint him as a greedy politicians. you have argued that you called his action stupid at one point but that they were not illegal. how you feel the potential crux of this argument was? >> we have always considered that they have the proven the crimes that the church. -- that of the charge. -- that they charged. >> have you shown in your weak spots at all to the government? >> i think we will be evaluating the verdict and looking at all the legal issues. >> do you plan on filing an appeal? >> yes. >> do you feel your defense is better suited to another court rather than a jury? >> we certainly believe that we have very strong the legal issues to appeal on. we have been fighting these issues since the day of the indictment. we feel very strongly about them. >> you that the prosecution to go over five weeks. he went about two hours and only call two witnesses. >> they thought they had proven their case. many of their witnesses were discredited. [unintelligible] that is why we handled it the way we did. >> and hind side would you change your strategy? >> no, i do not know it is good to replay what might have been. the judgments were sound. >> [unintelligible] >> you are watching public affairs programming of c-span. up next, iranian president ahmadinejad is sworn in for a second term. . after that, a senate hearing examined autism research here in the u.s.. ahmadinejad was sworn in for a second term. he called for national unity and criticized foreign government for questioning the validity of the election. this is courtesy of press tv, the english language news channel. >> i hereby swear in the name of almighty god to protect the system of the islamic revolution and the constitution and to use all my expertise and all i have in my power to this charge of responsibilities that i have undertaken and it to evoke myself to serve the people to the glory of the country and to the promotion of religion and morality and to support righteousness and to spread justice. and to refrain from being autocratic and to protect the freedom and dignity of individuals and the right that the constitution is recognized for the people. i will not safeguard the frontiers and political and economic freedoms of the country. i will spare no effort at safeguarding this and follow the guidelines of the holy province of islam. i will guard the power that the people have entrusted to me as the sacred trust. i will safeguard like an honor. i will later entrusted to who is elected by the nation after me. now we invite the president to address. >> in the name of god, praise be to god almighty and of the presence of god be upon the province of islam. i praise god almighty for giving the running people the chance -- the irony people the chance, who came to the scene in created -- the iranian people and created a scene on election day that without a doubt showed major changes of international levels. all those people who have helped and the thinking of the great aspirations of the nation, i would like to thank them all. to the people of the r iran, thy have always been active and have had a major role. today they are fully present on the scene and they are actually giving rise to a humane government with the nine characteristics. for 30 years we have been bearing the lack of dignity. with more -- the people have been ever more determined. the presidential election was a manifestation of people's face and following through the sublime aspirations of the revolution. there was an epic 40 million votes and casting 25 million through the elected persons is another source of pride for the i iranian nation. the magnitude of this can be seen in the anger and outrage of the enemies of human values. you can see this for yourself. there is a lot of dust in the air. they have raised lots of questions. they tried to depict a bleak prospect in the future of the irani nation. people are vigilant. they are aware. they rely on god. they are present on the scene. they will show there will and determination. they have exercised the power of the victor. -- exercise the power. the victor are the people, the values, and the establishment. the vote is the continuation of the path of the revolution and activities of the past four years. it has been symbolized by folks. prevailing justice, fighting, national dignity, independence, and persisting and resisting against the demands of bullies and prevailing brotherhood and justice. people have one more time addressed the capability, self- reliance, and the great capacity on the national level to move toward their aspirations. this was late on protecting our iranian and islamic culture, birds, and human resources -- culture, arts, and human resources. and protecting human dignity's and moral and spiritual values, affection and love for other people, freedom and acting independently from world powers. these are what is demanded by the people and endorsed by the people in the election. they want a model government. this is what they voted for. i respect the participants. i do not have any ideas other than serving the people in the country. i do not think of anything but progress and development as a nation. i am committed to all these commitments and aspirations. i have sworn, and you people i am committed. i have no doubt you also feel committed to the same principles. i mentioned the outlines of my plan. people strongly endorsed them. in the endorsement ceremony, i briefly highlighted those ends the leader of the islamic revolution also confirmed them. the plans today have turned to a demand by all the people and everyone is responsible for that. we are all responsible for that. we should join hands and tried to fill these. -- and try to fulfill these. who has voted for who? that is on the question. today we need a national will and results to join forces. i am confident that our brothers and sisters will be supporting the government in line with the fulfillment of these plans. the recent presidential election indicated the trade aspirations of the iranian nation. the people of iran capitalize on far-fetched ideas. they are going after sublime aspirations. the leader should deserve the right knee ia iranian people. we are representing a great nation. our nation has a great goals. great goals require great decisions in great measures, great actions. it strikes me to be taken -- stride need to be taken. we should make best of this chance. the past four years showed that capacities are abundant in the country. there have been some short punchinshortcomings. i announced that the government in the near term is the term and to use all of its force and serve the nation and to use all these potentialities and to activate the mall. this requires cooperation and support of the i iranian parliament. i once again with like to mention some of these islands of the plan. the first one is culture. maintaining the identity requires maintaining the elements, seeking justice, dignity, acquiring knowledge, affections, sacrifice, purity, and good deeds and moral by usv, art, literature, culture. they all need to be dealt with. great thoughts, wherever they are in the academia, thinkers, the lead of all kinds, they are the main assets of the country and the models for movement. we need to take more effective means for their presence and policymaking of the country against planning and execution of the planning. i would like to invite everyone here to join forces to move with us forward. the cultural diversity is an unprecedented beauty of the iranian nation. we need to protect this. the threat of terrorism is a main factor of cultural exchanges between iran and other nations. this should be given undue attention to. -- due attention to. our youth are the main activists of our country. they deserve to be actually active in different tiers like sports and scientific areas. women and girls in this country for the purist, kindness, and noble of women and girls in the world. they need to have a more constructive world -- role and show scientific, arps, political, and executive fields. they need to be more active in policymaking as well. iranians are able to inspire hope in the region and the world. this requires sparing no effort in getting the chance to everyone. family is the main killer for of bringing of the main kind -- mankind in security and peace in this country. everyone should respect the boundaries of the family. to protect everyone miss phil calm and tranquil. -- to protect it, everyone must feel calm and tranquil. there must be bravery in defending the oppressed. this should prevail. all individuals are first class citizens. they do deserve equal rights. they are equal. no one has any special concessions or privileges over anyone else. no one should feel that a right is trampled upon or they are not given a chance. no single individual should feel they are incriminated against. no one should feel their dignity is being entrenched. freedom is a divine gift. achievements -- everyone should enjoy and protect all this. no one has the right to limit social freedoms. the third point is the economic affairs. we see distribution of wealth. the on equal distribution should be stopped. it to be looked on as a national service. [unintelligible] structures and mechanism should be corrected quickly. all these must be implemented as soon as possible. targeted subsidies and the banking system, and taxing, and distribution and strengthening the running currency. these seem to materialize as soon as possible. -- needed to materialize as soon as possible. government has made relevant plans and they need to be correctly implemented. that requires brave decisions made by you parliamentarians. i do trustor open mindedness. -- trust your open mindedness. i do think we can solve the problem of unemployment and housing. these are all on the agenda of the government. you believe -- everyone should believe that. all disciplines i mentioned can be built quickly. we need to get rid of the imposed mechanisms and bureaucracy that only kill challenges and limits people and our human resources. you are going to make the destiny of our country. we should be rid of these restrictions. people have the capacity to do great things. it is you and me to need to be determined and take action. we still will continue with active foreign policy, with more power and with fresh plans a more effective plans. we will roll out an active role in all years. joint human values we will emphasize. we invite everyone to seek tranquility. we will resist the powers. we will try to correct the discriminatory mechanisms prevalent in the world. the people of iran still have our bearings of monism is an and justice. we should play an active role on an international level. we should fill responsible for the words and deeds. interferences, occupations, and cultural economic disturbances that arise from the policies, they need to be corrected. they need to be accountable for this. people of iran are for constructive dialogue. the pillar of our foreign policy is skillful interactions with all people and nations. however, some have violation of law and -- we will not remain silent. we want equal and friendly relations. this interference we will not tolerate. you just heard that some of those countries announced that the elections -- they do recognize the election but they will not send their congratulations. what does this attitude mean? the message is that they just want democracy in the service of their own interests. they do not respect the rights of other nations. the recognize himself as the artistry of democracy -- the recognize himself as the artistry of democracy -- they recognize themselves as the artistry of democracy. nobody in iran is waiting for anyone's congratulations. [laughter] the people of iran do not care about the frowning for had leaders that they care about and their smiles and congratulations. [laughter] [general crowthursday for a rese iranian nation. reachewe are reaching a chapter development for humanity. we need to realize our status but we need to fill our divine duty. we should come to believe that iran can stand on the peaks of progress. we can reach this and we should have our eyes cast upon the heavenly aspirations that will lead a side shortsightedness. we should believe that we can reduce that the government of justice is around the corner. [unintelligible] we believe in the dawning [unintelligible] i thank you all represented -- represented does, the people, the speaker. and also the respective heads of the judiciary and people of the guardian council. the ambassadors participating in the ceremony, people from different walks of life, i thank you all. >> you are watching public affairs on c-span. up next, a senate hearing examined autism research in the u.s.. after that, and update on the two journalists held by north korea to return to the u.s. today. >> sunday, a look of british politics on the bbc, including the expense scandal, recognition of the house speaker, and debate over military operations in afghanistan. sunday night at 9:00 p.m. eastern. >> on tomorrow mornings of a good washington journal" we are joined -- warning on "washington journal" we are joined by john solomon. the european parliament member daniel hannan but europe's economy in the health-care system. you also get an update on the nomination of judge should my door -- judge sotomayor . later, a senate panel discusses the u.s. postal service. they said they are set to lose more than $7 billion by the end of the year. this begins at 10:00 p.m. eastern. >> now a senate hearing on autism research. witnesses include the director of the national institute of mental health and the parents of children with autism. tom harkin of iowa talks. this is about two hours and 15 minutes. >> today's hearing is on autism intervention and research. the center for disease control says that one out of every 150 children born this year will be diagnosed with autism. among boys, the rate is even higher. we do not know what causes this disorder. most researchers agree that every discovery seems to raise more questions even though autism has not just one of genetic prospect but many. we still do not know with the turning mechanisms are. many experts think environmental factors may be a play. we do not know what they are exactly or whether they take effect during a child's first few months or years or maybe during gestation. we know a little bit more about interventions. some behavioral interventions in to help. we are nowhere near a cure all. this subcommittee has taken a strong interest in recent years. the fiscal year 2010 appropriations bill that was approved by the committee last week include a range of activities related to what some such as outreach and education, surveillance, medical research, and the inter agency autism coordinating committee. it also includes $40 million for a new program to help students with intellectual disabilities make the transition to colleges and complete their post secondary education. another problem is how to address the growing adult population with autism. i want to thank all the witnesses for coming here today. i will leave the record open for his introductory statement. we have two panels. the first is the director of the mih. akins boyd is from mississippi. david miller, va.. ms. dana however some from iowa. i think we covered all the aspects of you want to cover on autism on these two panels. first we will open up. as with all of the people testifying this morning, your statements will be made a part of the record in its entirety. we will ask you to go ahead and proceed as you so desire. >> i am honored to be here the other panelists. i know this is a very busy time for you and your colleagues. we appreciate your taking time here in the middle of the summer to hear about the latest research and the latest challenges with autism. the brief is to get you -- you a quick update on the research as we last met which is a little more than two years ago. this has been an extraordinary. with a lot of exciting progress. we are going to try to review the. the testimony i hope will be submitted to the record. rather than reading that, i thought i would take you very quickly through three questions. what we know at this time? what we need? what do we doing? we will try to summarize this very quickly. today you on track here, let me make sure we are all on the same page. autism by definition start by age three. we are talking about three different kinds of symptoms that characterize autism, reduce social behavior, abnormal language, and repetitive restrictive behavior's that often are called steer at peace. these are the definitions that many children come in with additional complicated features. i listed a few of them here. 20-30% will have associated seizure disorder that can be part of the autism syndrome. intellectual disability in various sorts. we have many families were concerned about gastrointestinal problems of many different kinds. about 10% of children who have an autism label have odd faces or appearances, we call this is more thick. somewhere between 10% and 20% have regression. everybody may regress to some degree. some seem to develop quite well for 18 months and then will lose language and function. the results of understanding these complicated features and the fact that this is such a heterogeneous syndrome is that we increasingly talk about all systems. there are many -- autisms. sometimes we are prisoner of our own language by thinking of it in the singular term. the term has been most widely accepted, the autism spectrum. all that means is that we are talking about a range with in the syndrome from those children who really have very limited functions and very little -- very really have limited language or severe debilities and they should no interest in social interaction. there are lots of motor after nemeses like hand flapping. they are the ones often have these distorted features. at the other end of the spectrum are children who are going to graves to be often highly successful. they may have social awkwardness or be called nerdy or more interested in numbers, but they may be tremendously useful and successful and made huge contributions. these will be areas that will allow them to use their oxygen to its best, which is the ball mechanical and numerical and less social aspects of the world. all of those people -- let's dive into what do we actually know what we have learned. i think there is wide recognition that this is a developmental brain disorder. we do not know yet where in the brain or what in the brain or went in the brain things go off track. the most recent research would suggest that what we are talking about here is not a specific region, but it may be more likely a problem of brain connections. that may be very diffuse. it is quite possible that the reason you see problems in language and social interaction is that those are functions that require the greatest numbers.. secure connections are not working, he can see deficits in those kinds of functions. there is been -- the greatest degree of progress has been internet. that is true in almost every area of the date has been genet is. that has been true in almost every area of science. -- the greatest degree of progress has been in genetics. that has been true in almost every area of science. two years ago when i spoke to you, i talked about how it will be important. we would have said that it was important because we know a couple percent of the children have recognized syndromes. these are single gene mutations that affect 50% of the children. in the last two years, we discovered a range of other rare but had a significant mutations. they are in the form of structural genomes seem to contribute. where two years ago and may have said 5% of any population of children with autism would have won in the syndromes, i think now we can say that number is 1 to be considerably -- adding now we can see that number is going to be considerably higher. there are new reports out about where mutations that may explain another 1% or 2%. there is clearly a genetic factor at work here. it does not explain all of autism. we still need to learn a lot more about how genes and environments interact. there will be more research about that in the future. that is an important area of progress. we spoke about this two years ago. as you said in your opening remarks, interventions are helpful. they are helpful when started earlier. the one to find this, because i think the issue here is making sure the best behavior of interventions are available to people who need them. we are not talking about children but also children transitioning into adult and adults themselves. these to work but they are not always available or paid for. we didn't have a conversation later about how that is going to happen. -- we do need to have a conversation later about how that is going to happen. we are sitting in a bar for how far these behavioral interventions will go it done early. the issue that you broke up -- brought of the opening remarks is one that is of great concern to you is the increase in problems. the centers for disease control and prevention now reports from 2007, a rate of 150 children being given a diagnosis. something on the autism spectrum, i do not think that number is a great variance of numbers we have seen elsewhere. it is also true that is about a tenfold increase over the numbers coming from the cdc. the increase is of great interest to many of us. i want to caution you that a change of prevalence is not unique to autism. we have seen a 40 fold increase in the prevalence of pediatric bipolar disorder. we have seen a tenfold or greater increase in detention -- and attention deficit hyperactivity disorder. this kind of a change is not unique to autism. it is certainly one that deserves our attention. we have to remember the difference between prevalence, which can be diagnosed by change in diagnoses, that could be a crew increase in the instances. that is an area that requires more research. that is what we know, what we need? part of what we need is filling in the gaps of what we do not know in taking you through the kinds of things we are talking about and understand more about the risk architecture of the whole spectrum. genes are important. environmental factors are important. most important will be how they interact. that is not unique for autism. that is true for autism -- for asthma, etc. new therapies and began to emerge. we want to understand this. the point is to be able to develop ways of protecting this disorder -- detecting this disorder much order. brain disorder behavior is one of the last features to change. that is true for alzheimer's, parkinson's, huntington's, and it will be imported to move upstream by having a biomarker allow us to detect risk in disorders much early. we want to have interventions such a more effective. behavioral interventions are fitted for many children but they are expensive, expensive -- extensive, and take a long time to work. we want to offer more than behavioral interventions. we want to know what he meant to work best for what people. you'll hear a lot about personalize medicine. we are hoping that the new director will be confirmed by the full senate this week. should that be the case, i think you will hear from him that there is a high priority. impersonalized money. -- there is a high priority put on personalize medicine. as you mentioned in your opening remarks, we have a whole wave of children of what is in that will soon be adults with autism. how we make sure that they have the access to services that we take care of this transition and the coverage deserves urgent attention from this committee and from others who make policy. luscious a little bit about what we are doing. i will tell you -- let's just talk a little bit about what we are doing. i will tell you that we are working with the coordinating committee. . . >> would happen soon thereafter with the american recovery in reinvestment act was the opportunity to make new investments to jumpstart the strategic plan, focusing on the short term objectives. we hope within the next six weeks to be able to announce publicly the large number of grants that have been funded through the american recovery and reinvestment act, including not only the special rfa to support new cotton is a research to the tune of $60 million, but also a large number of challenge grants and grant opportunity warrants that will be made and will be announced before september 30 of this year. finally, i will just mention that we have also tried to jumpstart much of this progress by creating a national database for autism research which will be essentially a meeting ground for scientists around the world to share data and share the tools necessary to accelerate progress in this area. as you will see in this plan, there were six questions that guided the effort to help us think about what were the most important issues. it includes both public members and federal members. these efforts came out of a rich discussion about what is that families and people on the autism spectrum most are looking for. we have taken each of these too hard and come up with a summary of what we know and what we need for each of the six questions. we have short-term and long-term objectives that are being addressed through the recovery act and other sources of funding. i will finish with this vision statement which i thought would be worth while steering with you -- sharing with you. that is to inspire research that will profoundly improve the health and well-being of every person on the spectrum across the life span. i cannot emphasize enough the importance of now attention to adults and soon to become adults with optimism. -- with autism. >> this plan will not only provide the road map for research but also set the standard for public-private cooperation and engaging the broad community who will be so invested in trying to make sure we expedite research progress. with that, i will make one final comment. and now you have been thanked for many things you have done, both for autism and for nih and many of the other issues to deal with. i would like to send a personal thank you for giving us allen murray, who will be joining hhs very soon. -- ellen murray. for those of us ofhhs, is a terrific gift. we are delighted that you saw to it to share her expertise with us, so thank you, sir. >> thank you very much, dr. isel. >> i am pleased to join you at this hearing to thank our witnesses who have come to share with us their experience and talk about what we can do to more effectively deal with the challenge of autism. we have had hearings before, but it is important for us to continue our efforts to stay up- to-date and join forces with the victims and their families to help make sure we triumph and did not like the victims and their families down. we want to support the calls. thank you for being here to lead it off. >> thank you again for your leadership. on the interagency coordinating committee, just looking at the list of people on the committee, as you know, our interest obviously is in research and finding causes, which hopefully will lead to prevention. also, we are interested in the early intervention programs and how you get to these kids early. do you have enough expertise on this panel in terms of, or you are looking at that aspect also? water the most effective early intervention programs -- what are the most effective early in a region programs we can find and work on? >> do we have the expertise? we bring in the expertise. each year we have to update the plan, and we do that by bringing in the experts in all the areas we are concerned with. we have heard about both ends of the spectrum, early detection and early intervention. as one of the places that needs a big push, the other end is adults on the spectrum who need a lot more in the way of interventions. >> which treatments and interventions will help? your group is actively out there looking at different interventions and trying to find out which ones work best, and all our -- are you also promoting -- or you instigating different types of early interventions to track them and see which ones work the best? >> let me just go through the process very quickly. the first thing we did was to do a portfolio analysis. this was unprecedented. in the questions of interventions or any other aspects of those six questions, we asked all the federal players, including the department of defense, but also the private groups which are very substantial players for autism. they are putting in significant amounts of research dollars. for the first time, everybody had shared their information about every grant a fund, how much they are putting into it. we were able to use that to map on to these six questions and see what is missing. one place where it looked like we were under invested across the sixth question is this area of interventions. how we feel that in? the first thing we do is bring the experts, at least on an annual basis, to tell us not only with the needs are, but what are the opportunities? what is really hot right now in terms of techniques, or things going on in other areas of medicine? the meeting this year will be on september 30 and october 1. we did a previous one which would have been in january of 2008, if i have that right. we used four days to hear from a broad panel of experts. i might add that is not only your typical academic grantee that we are hearing from. we are bringing in family members who may have had a very interesting experience that they think we should hear about. we are bringing in conditions as well who may be trying things we do not know much about yet. -- bringing in clinicians. we are making sure we get all the best ideas on the table before we decide what to recommend for nih and others to be looking at for funding. >> we are talking about applied behavior therapy. it seems to be successful. how early an age can you start that, and do we know what age you should start that? >> i am going to duck that question, because the world's expert, dr. dawson, is sitting right behind me. she has just completed the landmark study on that question, going as early as possible. i would love to steal their thunder, but because she is a friend and i do not want to alienate her, it would be better for you to hear from her directly about her own data. >> i hear a lot about this issue of vaccines and optimism. can you talk about the science regarding that issue? >> what we know is that there is no question from the community that there are internal factors at work, and that some aspect of the environment is going to be interacting with genetics to make children and maybe even unborn children vulnerable. it may be that these are prenatal internal factors. the only factor that has been explored in great detail would be vaccines. part of that has to do with an increasing number of vaccines. it has gone up over the past 30 years or so. i have made a slight so you can see what that looks like. there has been an extract -- a striking increase from 1900 until about 2009. there are more vaccines now in the recommended schedule. there are more injections that are possible currently. it is also important to realize that while the number of vaccines have increased, the quality of vaccines has really changed in the same time. if you look at the number of antigens that go into these vaccines, although it does not show it here, the amount of protein that goes into any -- into the full group of vaccines that children are receiving is less than they were when you are getting a single shot in 1900. the vaccines are for more refined and targeted. they look very different than they would have even when your children would have been vaccinated in the 1970's and before. it is not quite comparing apples and apples when you look at this change over time. the research that has been focused on vaccines has a potential association with optimism has been largely epidemiological research. up until this point time, there have been a total of about 16 studies involving hundreds of thousands of children. there is no evidence at this point of any association between vaccines -- the number and kind of vaccines and any of the things we are showing here and the increase or particular vulnerability to of schism. -- our vulnerability to optimism. >> how you can have a study of hundreds of thousands of vaccines -- if you go back to your first chart, i have a chart from the center for disease control and prevention that shows that in 1983, the maximum number of vaccine doses administered before age two was 8. in 2009, it is a minimum of 21, maximum of 29. from everything i can ascertain, it is closer to 29. so we have gone from eight in 1983 to 29 this year, before the age of 2. most pediatricians do that. so how would you ever find a group of kids that do not get those? there is a striking decrease. these are not the same formulations. they are not the same kinds of vaccines. what we are talking today, while the numbers have gone up, is a profound reduction in the amount of protein and the number of antigens. >> some of these vaccines were not around in 1980. we have a number of them here, some of these were not even around. hepatitis a -- they were not around in 1980. next the vaccines that were around in 1980 have been changed in many cases. they are not actually the same vaccines in many cases. >> they are the same. >> they are not the same. they may have the same names, but the formulation has been greatly refined. that is how you get these kinds of changes. >> i get confused in this area. i just want to focus on the number of vaccines, and the fact that they are sometimes put together before the age of two. i am not talking about that antigens, just the total number has gone up. i do not know of any studies that would compare a cohort of children from 0 to age two that did not get the shot and the incidence of autism. and those that did receive 29 vaccines and that did come down with optimism. i do not know of any study out there that has done is -- that did not come down with optimism. >> could we now a study of vaccinated vs. undetonated children? we do not have a vaccine expertise on that committee. we had decided to consult a federal advisory committee that reports to the secretary to get their expertise, because they do have it. we met about a month ago to have this conversation with them. before meeting with them, we said then the question, saying has there been such a study? just the kind you describe. if not, why not, and could we do such a study? their first response to us was, first of all, and has not been done. they did not think it was feasible to do it, but they did not think it was ethical. they had real concerns about the ethics of randomizing a group of children to not receiving vaccines, because they were concerned about the risk involved in not vaccinating a large number of children. you would need a very large number for such a study. >> so we really cannot tell that. i do know of people now with children who are not letting their children get those numbers of vaccines. some of these are highly educated, professional people, and they have decided -- they will not give it to them by the age of two, maybe up by the -- may be bought age of five or six. i know a lot of that is happening out there. a lot of pediatricians will not treat a child if, in fact, they are not getting these immunizations that -- will tell the parents that if you do not agree to the vaccination schedule, you cannot be a patient of mine. i know a lot of people that basically are not having their kids vaccinated. i do not know the ramifications of that. i just know that is happening. >> the problem is that we cannot know if 29 vaccinations by the age of two do have an effect. we do not know that. we are not only from those who are convinced that vaccines are the problem but those who are not. we have both ends of the spectrum. we hear from lots of families who have a child with autism and are wondering what they should do about their next child. that is often a question on the table, because they do not know who to believe and who to listen to. the group of people who feel that there really is an issue here and that we ought to be concerned because there is a relationship between vaccines and optimism point to the numbers, the large increase. all 16 studies demonstrate a relationship. however, those are all epidemiological studies, and you cannot rule out the possibility that there is a small signal there that might have been missed. on the other side of the coin, the other end of the spectrum, we are hearing from other people, not a scientist, but even family members on this committee who are saying enough, already. if there is an internal factor at play here, and we have spent a lot of money and time during the 16 studies and nothing has shown up on this question, maybe we do not need to turn that rocked over a 70 time. let's move on and look at something that is more likely to shed light on what could be an important factor in increasing prevalence or the risk for autism. that is what we are hearing. we are trying to balance both of those points of view and also trying to make sure there is information available for those who are concerned about what to do with their next child. >> early interventions and how we help people right now who are having trouble dealing with children. we have to focus on those early intervention programs. we will get to that in the next panel. >> i want to join you in welcoming ininsel to the hearing. we have had hearings in the past to try to develop a body of information that will help us identify better ways of dealing with autism. are there other causes? what are the possible changes in environment or nutrition, health care generally that we can turn to for help in dealing with the challenges and difficulties that optimism brings to our society -- that altruism brings to our society. going on television, inviting people to contribute, and some of the experiences i had then, observing the children who were victims of autism and talking with families and getting to know more about it really made a big impact on me and how challenging the situation really is. my heart goes out to those families who are dealing with it, and i just want to be here today to support the effort to identify how government can be more helpful. what are the other possible causes for autism, and what are the things we can do? and to continue to work and not give up. a lot of people have invested time, ever, research dollars, personal energies, to cope with this situation. i am curious to know from you, is there hope? have we discovered things and learn things over the last several years as we have been embarked on this joint effort that give us any hope that we are making progress? >> absolutely. there is always hope, but there is even more than that right now. there is very rapid progress. i think is next. time is going to be even more extraordinary -- this next period of time is going to be even more extraordinary. in 2008, our budget for autism research went up, and it will go up even more in 2009 because we are seeing this recovery act effort. we have put money specifically into an all it is requests for applications through the recovery act. the only disease specific such request in the recovery act from nih for this year, this is the one that does have a disease name on, because we realized that there is an urgent need, and equally important, there is a tremendous opportunity right now for progress. we have the tools we need so we can really start to move quickly. we want to do that over the next two years. >> thank you very much for your efforts and being involved as the director of the institute of mental health. we appreciate your being here with us this morning and helping us fully understand the challenges we have ahead. >> thank you for your interest and support. >> would like to call our second panel. i did not talk to you earlier about this, but if you have the time to stay, i would appreciate that. if you could stay for a second panel, i would appreciate that. >> i would be happy to stay, and most of all i want to hear the copal analysts, because i think all of us need to hear some of the experiences picture >> you can stay where you are, you do not have to move. let's call our second panel, but dr. geraldine dawson. let's start from left to right as i call your names. mr. joshua cobb's, miss boyd, david miller, and dena halverson. >> thank you all for being here. some of you have come a great distance. your statements will be made a part of the record in their entirety. you kind of summarize, 5 minutes or so, i would appreciate it very much. we will just sort from left to right here, dr. geraldine dawson, the chief science officer for autism speaks. dr. dawson received her ph.d. from the university of washington. thank you very much, and please proceed. >> good morning, mr. chairman. i want to thank you for inviting me. i am very honored to appear before this subcommittee, and i want to thank the committee members and you for your leadership in providing full funding for the combating autism act, and also for your most recent fiscal year appropriations bill. this year, more children will be diagnosed with autism, as you may know, than with age, diabetes, and cancer combined. autism research, however, is still significantly underfunded, despite greater public and congressional awareness. for example, leukemia affects one in 25,000 people, but receives research funding for $310 million annually. pediatric aids affects one in 8000 children. its funding, 200 feet $5 million a year. autism, as you know, affects one in 150 individuals, individuals,nih funding for fiscal 2009 is estimated to be $122 million. as you have heard, most scientists agree that autism is caused by a combination of both genetic risk factors and environmental factors. we have discovered some of the autism risk genes, but we still know very local about the role of the environment and how it interacts with these genes. we have come to understand that optimism is not one disease, but many different diseases. has many different causes, and each costs will likely only explain a minority of cases. piece by piece, we must discover each of these causes so that effective treatment and prevention will be possible. to identify the causes, it will be necessary to invest in large scale, population based studies that broadly examined genetic factors and internal trekkers, such as the nih national children study. it will be important to invest in large skillet databases such as the national database for autism research, the genetic the resource exchange, and the optimiautsim tissue exchange. research suggests that it may be the connection between brain cells. some of the best it is in the world are working hard at understanding how genetic mutations can change the way in which neurons communicate, and they are developing therapeutic strategies that might restore the function of the synapse. all this work is offering real hope, the pace of discovery is simply too slow, in large part because of lack of adequate funding. we can now screen for autism at 18 months of age. of his and speaks is funding several clinical trials that are evaluating interventions for at risk infants who are as young as 12 months of age. the hope is that by detecting autism early, we will be able to reduce its severity or even prevent the syndrome from developing. however, the impact of this work will not be felt less pediatricians are using the available screening methods, and parents have access to train professionals who can deliver these interventions. that is why it is critical that we continue to study dissemination methods, invest in training professionals and caretakers, and support federally mandated insurance coverage for behavioral interventions, which we know are cost-effective in the long run. all behavioral interventions or effective for some individuals, most individuals with autism suffer without relief from the optimism itself and a wide range of medical conditions such as sleep disorders, gastrointestinal problems, and epilepsy. very few clinical trials have been conducted that address these medical conditions, and virtually no cost effectiveness studies have been conducted to determine which treatments are most effective. thus, parents are left to sort through confusing and often inaccurate information about the various treatment options and claims. clinicians are often at a loss in helping parents to make evidence based treatment decisions. this gap in research must be addressed. very little research has been conducted that addresses the issues that adults with autism face, despite the fact that adult care accounts for the bulk of the $35 billion that is spent annually on caring for individuals with autism in the united states. unlike other health conditions, we have limited information about autism health care utilization, barriers to access, health care disparities in the u.s., where cost effectiveness models. mr. chairman, over the past two years, your subcommittee and you have been responding to the challenge of autism with resources. this is beginning a meaningful fight against this very challenging disorder. but more is needed to better understand the disorder, diagnosis, and to better treat those individuals who have it. i want to end by thanking you for your time, for your commitment, and for your leadership. i am very happy to entertain any questions that you may have. >> thank you very much, dr. dawson. before we go on, i want to recognize my good friend and colleague from pennsylvania, with whom i have shared the gavel here over the last almost 20 years. senator specter is a member of the judiciary committee. they are on the floor now with the sotomayor ofoundation. >> thank you for yielding. we are taking up the confirmation hearing of judge sotomayor or for supreme court. i am due on the floor shortly, but i wanted to thank you, mr. chairman, and the ranking member for scheduling this hearing on this very important subject, and thank the witnesses for coming in. autism is a heartbreaking alemaailment. one of the toughest part is talking to parents who have children suffering from autism, and there's a real question of doing more. we have worked hard on funding for the national institutes of health. for a decade, we are able to raise funding from $12 billion to $30 billion, at a time when senator harkin and i have transferred the gobble -- gavel. regrettably, that is not enough. i know that funding for autism is slightly under $52 million, up to $122 billion now. cdc funding has increased to little over $22 million. we have been successful in getting it -- getting into the stimulus package $10 billion. it is my projection that some of that will be going to autism. these funding levels were set by nih in order to avoid what we call politicization. our job is to get the money, but not to distribute it. i think there ought to be a bigger share for autism. we are pushing to make that happen. on comprehensive health care reform, which we are working on now, we are trying to get $10 billion added as a base, and start with $40 billion, which will give us an opportunity to do more. staff will be here to follow the testimony and will have a chance to review it. i appreciate your coming in, and you have are assurances we will do everything we can on this very important malady. >> i understand you have to be on the floor for the nomination. now we will go to mr. cobbs. if i remember right, you are from iowa, of near sioux city. you or the chairman of the iowa autism council, the father of a nine year-old boy, no, with autism. i understand your wife, tina, is with you. >> you have two other children, and you were here at our last hearing a couple of years ago. >> i was in the audience at the last hearing. >> i am interested in what has happened in the last couple of years, so welcome to the committee, and please proceed. >> thank you for having me. good morning, mr. chairman, and members of this distinguished committee. high and the chairperson of the iowa autism council. i am the parent of a child with autism. i spent over seven years trying to better the lives of individuals and families affected by autism through insurance and education reforms. when i was last in front of this distinguished committee, spoke of the successful and cost- efficient service is my son received. these services were provided in my home in iowa from professionals in florida through the celeste foundations federally sponsored national research project. we are one of 15 families that participated in this demonstration across the nation. in this model, after a brief phase of on-site, face-to-face training, which is crucial to build up their peake relationship, we were linked by an interactive video system that allow consultation and support directly into our home, when and where we needed. for this model, we receive professional support in teaching our son language, life skills, and overall improving its quality of life. one of the main components of the study was the reduction in our family stressed for empowering us as frontline teachers and therapists. additionally, through training and education in this project, we had a better understanding of our child condition and those things we could do to bring to bear to improve his life. not only did improve my son's quality of life, but it had an impact on my family as well. also as a family, which showed a dramatic reduction in stress, anxiety, and became more focused as a family unit. i will never forget the call from my wife saying it will never guess what our son did. he went potty on the big boys potty. this becomes a super milestone when your child is five years old and has the additional burden of societal rejection. we are given the right teaching skills and able to achieve what previously was unobtainable. our experience is chronicled and aired during autism awareness month. we have footage that we would like to share with the committee and it can also be viewed online. i cannot stress enough that the needs of a person with autism do not convene with professional hours or appointments. just having the support in my home and allowed natural interaction for my son and allow the professionals to see the behaviors as they really occurred. as chairperson of the iowa autism counsel, i had the opportunity to speak with many family members and stakeholders within the autism community to learn their needs. from my perspective and my experience, these families are desperately in need of services. today, as parents search online for opprobrious services for their children, they are confronted with an array of and validated technologies and various individuals claiming expertise in treatment. unfortunately, there are no safeguards in place to protect vulnerable parents and children. for example, from anywhere in the world, anyone with a personal computer, a web cam and internet access, can offer internet services termed as advice. under the circumstances, any individual or group can claim qualifications in helping parents and children with autism. not only our families experiencing the emotional burden of treating the child the disability, but they also had the financial burden of paying for this treatment with no assurance as to the quality of care provided. when individuals or organizations are collecting fees for services and can distance themself into the cloud that is the internet, what can families expect? the reality of standard setting is evident, because without standards, there can be no reimbursements. all the systems are cost- effective, without proper reimbursement model, they still remain unattainable for most parents. they are struggling financially to find care for their children. millions of dollars are being placed into rural networks. however, few if any methodologies exist. the current wave of statewide health insurance requirements and to abide reimbursements for individuals with autism do not have well-defined standards for reimbursement. in the absence of consistent reimbursement policy and standards, families and children are not granted access to proven an effective care. i know this committee has recognized the need to assess "best practices and professional criteria standards, and to make recommendations to the committee concerning national standards that advances and encourages this type of technology." i commend the committee's foresight and urge that this momentum continues. in closing, you may be wondering how my son is doing today. he is now 9 years old, and my family is still utilizing this technology. we are addressing such behavior is as expressive language, academic skills, just to name a few. it is important to note that as my son grows, his treatment program continues to grow at a direct -- and address his ever evolving needs. it has been an effective delivery system for our family. has been so effective that now might 8-year-old daughter has become a mini-therapist, using teaching strategies that we learned in the program with my son. at this point, he continues in the role of student and teacher to us all. indeed, his future is bright. i would like to thank you for your time and the opportunity to share our story and the stories of thousands of families here today. thank you. >> thank you very much. we will have some questions for you later. now we turn to the vice chairman of the mississippi autism task force. an attorney and mother of two children, her second child developed aggressive autism at around 22 months of age. she was recently appointed to mississippi's department of education, special education advisory committee. she attended mississippi state and received her doctorate from ole miss. >> i want to thank this committee. on behalf of the many families with optimism that i represent. we have had various meetings throughout the state of mississippi. in fall of 2005, our family was living in san antonio, texas, has been completed his fellowship. my of his job, at the age of 22 months developed regressive autism. almost overnight, he digressed from using words and sentences into language with fine and gross motor coordination well above his developmental pierce, to someone who lost almost all of those skills sets. it was as though a tornado had hit our lives, and there was no end in the foreseeable future. at age 25 months, i son began a rigorous program filled with behavioral, speech, and occupational therapy, that has continued after our move back to mississippi. currently we can see progress, and we are cautiously optimistic about the future. he is quite verbal and his gross and fine motor skills have greatly improved. his medical condition is always tenuous, as he is believed to suffer from mitochondrial disorder which is supposed to be contributed factor to his autism. simple viruses will turn this very high functioning child to love functioning child within just a matter of hours. today, he will attend his kindergarten open house in oxford, mississippi. he will attend a regular education class and have some classroom resource assistance. as a class of 2022 starts kindergarten, schools across the country will look very different. 20 years ago in this country, he would probably have been the only child in his class with autism or even his old school district. -- his whole school district. his kindergarten class will have six children diagnosed with autism spectrum, all of them very high functioning. if you do the math, that is roughly one in 34. in mississippi, according to surveys, we know that children typically do not get diagnosed much later than 5. that number is probably going to go higher. this is a very high number compared to what we see as national statistics, but i think you can see this number replicated in kindergartens throughout this country in various places. we know that the rate of autism goes up 10%-70% per year. can you imagine what autism is going to look like in the next decade? the medical establishment gives itself a pat on the back for saying they are doing a better job diagnosing this, but we know there have to be contributing factors that are the root of this increase. better diagnosis does not completely explain the explosion we are seeing here in america. we often see adversarial relationships develop between pediatricians and family members who believe that there autism was caused by vaccines. we also see adversarial relationships when parents do not accept the advice of physicians that there could be multiple causes of autism, and reach an impasse. the autism society of america currently estimates that the lifetime cost of caring for a child with autism is from $3.5 million to $5 million. taking those numbers, we are looking at facing almost $90 billion annual cost in autism. the question we have to ask is, can we afford not to put the money into research and treatment, if these are the numbers we are looking at? i am glad you are sitting beside me. the combating of citizen group brought great hope to parents. --, adding optimism grew. we have to move quicker. we have to see the coordinating committee look at all aspects and possible causes to autism. we also have to see that committee quickly make some identifiers and look at populations of these children's to find out what are the general pictures we see of these children's parents, their family members. what are some health indicators that we see? in has to be done quicker than we usually operate at government bureaucracy levels. the other thing, i would be remiss in represent the parents across this country if i did not go back to your question. we have to look at the causation with vaccines. dr. healy, who i am sure has testified many times, and does not have any financial interest, has noted that there is a dearth of research in truly looking at the vaccine-odd to some connection. there are some very good steadies' that have yet to be done -- the vaccine-autism connection. i know this committee does not like to tell the nih how to spend those research dollars, but on behalf of parents across america, i ask that you look at this when you are confirming a new nih director. i want to give you some optimism. in this classroom, five of those children have been blessed to be able to receive intensive behavioral therapy. their families have in one situation taken to jobs to be able to afford this intensive behavioral therapy. that is not often the case in mississippi, and is a rarity. the average annual income in mississippi is less than $35,000 a year, and yet this private therapy runs most of us around $50,000 a year. it is impossible for many of the constituents back home to a for the therapy that they know will make their job better. -- to afford at the therapy. i beg you to look at ways that we can afford intensive behavioral therapy for all children. these children that i mentioned who have received this therapy, even at the age of 5, they already are requiring less classroom support than they would have. you can see the financial bright spots down the road of investing in early, intensive behavioral therapy. the question i will leave you with is, if we know that we are looking at a $90 billion annual health care cost, and we are looking -- we are looking at initial investments of around $32,000 a year, and we know that over that child's life, we can see health care returns at roughly $2.5 billion of health care savings for their children who get this, the question is, can we afford not to make that investment? >> a very profound statement. thank you very much. now we will turn to david miller, a resident of fairfax county, virginia. he is on the board of directors at northern virginia community college where he co-founded the consortium on autism and intellectual disabilities. he has a master's in public administration and a law degree from george mason university. he is retired from the armed forces and the father of two identical twins who have autism. >> thank you very much for holding this hearing. as the chairman indicated, i am a board member. we are the second-largest many college in the nation. i and the co-founder of the consortium on autism and intellectual disabilities, comprised of 41 community college presidents. i am pleased to say that a colleague is a very active member of our consortium as well as the president of hines community college, which he tells me is the largest one in mississippi. both of these leaders could not be here today, because a previously scheduled board meetings, but we do have some community college presidents here that i would like to introduce the subcommittee to. the first one is willing duncan. he is the chairman of taft college and the chairman of our consortium. we also have dr. wayne burton, president of the north shore community college in massachusetts. we have the chairman of passaic county community college. also with the is jeff ross. if you look at my testimony, the summary of the measurable results that taft has achieved these last 13 years with respect to students with intellectual disabilities and developmental disabilities is astounding. at the committed college level, we aspire to have programs that affected. this hearing has particular poignancy to me because i am the father it of 27-year-old twins who have autism. their sister is the youngest of these, and thankfully -- she is the youngest of these triplets. thankfully she is a healthy, happy, seven year-old. i am concerned about the long- term viability of these children to live independently and develop a career checked that will allow them to support themselves financially well meeting in overcoming challenges that you and i have never faced in our entire lives. i am not as educated as some of these presidents. i am not as well versed in the nuances of optimism or as well read as my wife, who on a daily basis meets the challenges. she is a wonderful and very accomplished woman. she should be seated in this interest -- in this witness chair. when you do the next hearing, she needs to be invited. people talk about takeaways. i think that when you go on to further activities, the two takeaways i would like to have for my testimony or, number one, my kids are here to stay. what you are doing with respect to research is excellent. we need to invest funds in screening in diagnosis and all that. we need to do that, but having said that, my kids are here. all the panelists who have autistic kids are here, so what are we going to do with these kids? as i talked to more advocates and opponents, what is the game plan here? what are we looking towards and working for? most of these kids are below the age of 17 at this stage, but more and more of them are entering middle school and high school. at some point, they will be adults. what are going to do with these kids? that is a critical question will have to consider. we have to keep that objective in mind. at the community college level, we are seeing our first beginnings of autistic kids on our campus. you are chairman, chairman kennedy, obviously gets it. we have had a number of discussions, and he has called this a tsunami. he said debt -- based on his offer ship, he authorized awarding five-year grants in support of model demonstration programs that promote the sec's -- successful transition of students. i have a letter from senator kennedy where he requests funding for these types of programs. the reason for this bunning request is that the vast majority of autistic and disabled students are currently in committee colleges and will attend community colleges because we have open admissions policies. they reach age 21, and the, on our campuses. they are here, and frankly we have no effective programs to deal with these children. they enroll in normal academic courses and are soon put on academic probation, and then soon academically dismissed, and that is in it. they have no further contacts with respect to job training programs. they have no further or additional educational opportunities. that is it. what happens to these kids after that? that is what senator kennedy is really focused on. some schools will tell you, these are expensive programs. they run roughly $30,000 a school. there are limited by law to approximately $2,000 to $3,000 for tuition. they do not have access to any further funding. with the reduction in state operating funds, they did not have the financial resources to develop programs to assist the students. i know i am over my time. these funds are are essentially economic development funds. they are essentially local stimulus funds. they will be focused in life skills training and vocational training. we appreciate the fact that you have seen fit to put approximately $80 million for this program, and we hope that in conference, you will walk away with at least that minimum amount of money. again, thank you very much. >> now we have a co-founder of beat iowa. usually we do not say that. [laughter] i should have looked at that before i set it. -- before i set it. that could be misinterpreted. she lives on a farm in north would, iowa, way up in northwest iowa with her husband and three children. her 7-year-old daughter, robin, was diagnosed with autism when she was 15 months old. she has a b.a. in french from southwest in receipt. >> she was diagnosed a little before age 3. her diagnosis was that three years and three months. >> thank you, mr. chairman and colleagues for this opportunity to encourage more thought and action on autism. and a daily basis, i am a wife and mother of an iowa farm family. i days are filled from very early to bury late with joyce, blessings, and challenges of my three children. i have one daughter who has heavy-metal toxicity. her original diagnosis and just over age three was of his mental retardation. although my daughter was given the label of autism, this failed -- this term fails to describe the nature of her disorder. after her diagnosis, i discovered by medical origins of our condition. over the next several years, we confirmed multiple medical diagnoses, including intestinal this bias is, multiple few -- food allergies, growth hormone deficiencies, in the crib disfunction, pituitary dysfunction, hypothyroidism, allergic colitis, and heavy metal toxicity, to name a few. we have only been able to help robyn by struggling to travel all over the country and working with many medical practitioners, spending thousands

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