Autism Reality

Autism : Irish Protest Failure to Fund ABA Schools for Autistic Persons


New Brunswick and other Atlantic Provinces have strong historical ties to Ireland as many of our citizens arrived here escaping the destitution of mid-19th Century Ireland. Their descendants, including the occasional autism blogger, form a significant part of the local population today. We also have in common a reluctance on the part of government decision makers are to take the necessary action to provide needed ABA based educational instruction to autistic persons.

Autism protesters slam funding of specialist education

Several hundred parents and supporters have protested outside Leinster House over the Government’s failure to properly fund applied behavioural analysis schools for autistic persons.

Three hundred and forty-seven black balloons, one for each child currently on waiting lists for ABA schools, were released into the air outside the main gates of Leinster House.

Irish Autism Action spokesperson, Mark De Silvo, said the Government is out of touch when it comes to education for those with autism.

http://tinyurl.com/33728l

April 27, 2007 Posted by | aba, applied behavioral analysis, autism advocacy, autism disorder, autism education, autism protest, Ireland, Irish Autism Action, Mark De Silvo | Leave a comment

The Face of Autism – Loss of funding spells loss of skills


The Daily Gleaner/David Smith ph

I have on previous comments applauded New Brunswick Premier Shawn Graham and the Liberal government for its promise to train 100 TA’s and Resource Teachers a year at the UNB-CEL Autism Intervention Training program. Some TA’s and teachers have already received the training but the commitment made during the election campaign by Mr. Graham is being held up now and, it appears at least, that the commitment is in serious danger of being abandoned or watered down beyond recognition, replaced by in house training by the Department or some other “innovative” alternative. While we remain hopeful that the pledge will be honored we are aware of positioning by the Department of Education officials that would see training of much less quality and integrity than the UNB-CEL program offered by the Department. The attached article from the Daily Gleaner here in Fredericton New Brunswick illustrates the predicament faced by autistic children who have been receiving intervention when the turn five years of age in New Brunswick.



Loss of funding spells loss of skills

By JACQUELINE LEBLANC
leblanc.jacqueline@dailygleaner.com
Published Monday April 23rd, 2007
Appeared on page A1

Tying shoes is a simple task for most eight year olds.

But for Austin O’Donnell, it takes a little more practice.

Austin is autistic, and through intervention therapy, he learns many skills that don’t come easily to him.

Just tying his shoes was broken down into 25 steps to make the task easier for him to remember.

But without continuing the therapy, his mother Jennifer O’Donnell worries Austin may lose some of the skills he worked so hard to acquire.

The government funds an intervention program for preschool-aged autistic children.

Applied behavioral analysis intervention therapy is the most popular and most successful therapy for autistic children. It’s not a cure for autism, but it helps children reach their maximum potential.

But once the child enters kindergarten, the funding stops. But that doesn’t mean the intervention should stop too, said O’Donnell.

That means big money for parents who have to hire the intervention workers themselves.

For the last three years, O’Donnell has organized a benefit dance to try to raise enough money to be able to hire an intervention worker to spend time with Austin every week.

“There are no resources,” she said. “I’m a single parent. I’ve worked two jobs and held the benefit dance for the last three years to split the bill financially. And I’m willing to do that.

“If I don’t fund raise, he simply won’t have it. To me, that’s just not an option. I’m hoping at some point that there’s going to be a change, where (the government) provides some funding.”

Austin was diagnosed with autism when he was four, so he only took advantage of the therapy for eight months before the money stopped.

“I knew the funding would be cut when he entered school,” she said. “I knew that in my mind, but it didn’t really hit me that there was nothing. And, when it happened, I just thought quickly, how can I raise money to continue this?”

The dance usually helps fund about eight to 10 months of intervention therapy.

Most autistic children have a teacher’s assistant in the classroom. But they’re not all trained for autism intervention.

Harold Doherty is with the Autism Society of New Brunswick. His 11-year-old son Conor is autistic.

He said it’s important that the intervention therapy follows the children into the schools.

One way of doing that, he said, is training the teacher’s assistants (TAs) to be qualified to do autism intervention.

“We’re pushing to get the TAs trained,” he said. “If you’re going to have a TA anyway, that you need in most cases, why not train them in some way to be effective to help the children learn?”

There is a course at the University of New Brunswick that trains resource teachers and teacher’s assistants in autism intervention.

Doherty said the Liberal government promised that it would train 100 teacher’s assistants and resource teachers at UNB per year for four years.

This would help autistic children have a chance to have a trained teacher’s assistant.

Yet, Doherty said, there still hasn’t been any move on the promise, and the autism society is worried the government is stepping back, or planning on watering down the promise.

But O’Donnell can’t wait for the teacher’s assistants to be able to take over the intervention work. Austin needs the help now, she said.

“He’s beginning to get to an age where he’s struggling socially,” she said.

“And that’s a big deal because if he’s having troubles at school in that way, then it’s causing a whole other can of worms.

Loss of funding spells loss of skills

“Not wanting to be at school, and being upset all the time, and not really understanding why he doesn’t have friends or why he has such a hard time keeping friends. We’ve been working on that for the last year.”

O’Donnell works with her son on evenings and weekends at home, but she said he needs more intervention time than that.

She said every little bit of therapy can help her son in big ways.

The benefit dance will be held Saturday, April 28, at the Tier II Lounge, above Winners Restaurant on the exhibition grounds at 9 p.m.

Tickets are $20 and can be purchased at Mazzuca’s on York Street.

April 23, 2007 Posted by | applied behavioral analysis, autism education, autism interventions, Education Minister Kelly Lamrock, election promises, Premier Shawn Graham, resource teachers, teachers aides | 2 Comments

Real Autism Awareness – Early Intervention is Vital

As my son ages, he is now 11, I continue to fight for improved health, education and residential care for him and autistic persons on all points of the spectrum. In doing so I have not lost sight of the critical importance of early intervention for improving the life prospects of autistic children. I am not, and never will be, one of those who believes that in order to accept, love and find joy in my son I must accept and find joy in his autism.

To parents of newly diagnosed autistic children I say over and over again – do NOT listen to the sometimes irrational voices that tell you to accept and embrace your child’s autism. Autism is by definition a disorder, a condition which brings with it many deficits in thought, communication, and behavior. True there are some savants and there are many high functioning autistic persons who have social deficits and some communication limitations. But there are also many lower functioning autistic persons for whom the reality IS life in residential or institutional care. It can be a life threatening and dangerous condition.

Love your child as he or she is, complete with his or her autism. But do not mistake your child for his or her autism. Fight to improve your child’s lot in life no matter how many hand wringing, joy of autism advocates tell you that you are suppressing and rejecting your child. They will not be there to help your child when he bites himself repeatedly, when she wanders out the front door only to be found hours later, or when you are sick, elderly, infirm or deceased. They are interested in their agenda not in your child.

The most important way to help improve your child’s abilities is to get as much behavioral intervention as intensively and as early as you can. ABA based intensive intervention meets the evidence based standards of federal, state, provincial, professional and academic autism organizations across Canada and the United States. To date it is the ONLY intervention that meets those high standards.

I am not alone in counseling new parents to seek as much early intervention for their autistic child as possible. There are many others. The following letter from the Journal-Standard really struck me because it was from the mother and father of an 18 year old young autistic man who also urge parents to seek early intervention for their autistic children.

J-S LETTER: Early intervention vital in autism awareness

Published: Saturday, April 14, 2007 9:44 PM CDT
E-mail this story | Print this page

April is Autism Awareness Month. As parents of an 18-year-old son with autism, we are pleased that unlike 15 years ago, when our son was first diagnosed, the term “autism” brings thoughts other than from the movie “Rainman.” But there’s still a long way to go! Today, one in 150 individuals is diagnosed with autism. That is more common than pediatric cancer, diabetes and AIDS, combined! This epidemic needs to be addressed by all areas of society. We have a whole generation of children that have become “lost in autism.”

The following is an excerpt from http://www.autismspeaks.org. Please familiarize yourself with autism and its characteristics:

“Autism is a complex neurobiological disorder that typically lasts throughout a person’s lifetime. It is part of a group of disorders known as Autism Spectrum Disorders (ASD). It occurs in all racial, ethnic, and social groups and is four times more likely to strike boys than girls. Autism impairs a person’s ability to communicate and relate to others. It is also associated with rigid routines and repetitive behaviors, such as obsessively arranging objects or following very specific routines. Symptoms can range from very mild to quite severe.

Autism Spectrum Disorders can usually be reliably diagnosed by age 3. Parents are usually the first to notice unusual behaviors in their child or their child’s failure to reach appropriate developmental milestones. Some parents describe a child that seemed different from birth, while others describe a child who was developing normally and then lost skills. Pediatricians may initially dismiss signs of autism, thinking a child will “catch up,” and may advise parents to “wait and see.” New research shows that when parents suspect something is wrong with their child, they are usually correct. If you have concerns about your child’s development, don’t wait: speak to your pediatrician about getting your child screened for autism.

If your child is diagnosed with autism, early intervention is critical to gain maximum benefit from existing therapies. Although parents may have concerns about labeling a toddler as “autistic,” the earlier the diagnosis is made, the earlier interventions can begin. Currently, there are no effective means to prevent autism, no fully effective treatments, and no cure. Research indicates, however, that early intervention in an appropriate educational setting for at least two years during the preschool years can result in significant improvements for many young children with Autism Spectrum Disorders. As soon as autism is diagnosed, early intervention instruction should begin. Effective programs focus on developing communication, social, and cognitive skills.”

For further information about autism, please go to http://www.autismspeaks.org. Also, on their Website is a very informative 13-minute segment entitled, “Autism Every Day.” It gives an accurate portrayal of what life is like for an individual with autism, as well as how it affects the family.

Steve and Marie Bernhard

Freeport

http://www.journalstandard.com/articles/2007/04/15/opinion/opinion95.txt

April 15, 2007 Posted by | aba, applied behavioral analysis, autism awareness, autism disorder, autism speaks, early intervention, Journal Standard | 1 Comment

Politics Blocs Help for Autism – Quebec



The motion by Charlottetown Liberal MP Shawn Murphy which would have amended the Canada Health Act to ensure funding for ABA treatment for autism was defeated by an alliance between the Harper Conservatives and the Bloc Quebecois. Mr. Harper and his Autism Front Man, Edmonton area MP Mike Lake, a father of an autistic child, argued that such an amendment would have constituted an intrusion into provincial jurisdiction. The Bloc in order to justify its existence in a federal parliament must be seen as fighting federalist intrusions into any aspect of Quebec life. But what did it cost Quebec children with autism for Quebec’s purported separatists to grandstand and obstruct in the name of political ideology? Are Quebec children with autism different than children with autism outside Quebec? Is the Quebec government so wealthy that all autistic children are fully funded for effective ABA treatment?

The answer to both of these questions is “No” as the following excerpt from the CASLPA Canadian Association of Speech Language Pathologists and Audiologists presentation to the Canadian Senate makes clear:

Quebec

The standard of care for ASD in Quebec is Applied Behaviour Analysis (ABA), but given that ABA is an intensive, one-on-one program involving roughly 20 hours of therapy a week, the province does not have sufficient resources to provide every autistic child with ABA when the treatment is needed.

In Quebec, the waiting list for ABA can be anywhere from six months to a year after diagnosis. This is challenging for hospital staff as speech-language pathologists are there to assist with the diagnosis but there is not any on-going mandate to provide treatment. Frustration with ABA waiting lists has caused speech-language pathologists and psychiatrists to seek out more cost-effective therapeutic alternatives, such as intervention programs that are designed to help parents support language development in their autistic children.

http://www.caslpa.ca/PDF/SenateCommittee_bried_nov2006.pdf

Unfortunately for Quebec’s autistic children politics Bloc’d a serious effort to provide funding for the effective ABA treatment their parents seek on their behalf.

March 25, 2007 Posted by | aba, applied behavioral analysis, autism disorder, bloc quebecois, Canada Health Act, Gilles Duceppe, Mike Lake, Stephen Harper | Leave a comment

Autism Is a Disorder, Not Just a Different Order

Denial is one of the first problems encountered by parents of newly diagnosed autistic children. The challenge of facing up to the reality of an autism diagnosis for your child is huge. Once a parent gets past the denial stage they must deal with helping their child to the fullest extent possible. There is no doubt amongst those who seriously seek improvement in the abilities of their autistic children to live a full and happy life that intensive early intervention is absolutely necessary. Nor is there any serious doubt that behavioral intervention is the only evidence based intervention currently available to help your child. But for the parent starting out on that effort you will receive some misleading signals from advocates of the “neurodiversity” movement. Although much of the rhetoric emanating from the neurodiveristy direction is confused and contradictory, in its essence neurodiversity states that “autism is not a disorder, just a different order” to use the words of a high functioning autistic person who called into a CBC radio talk show on the subject of autism.

The neurodiversity movement, if it presented the positive attributes of people who happen to be autistic, or presented the whole picture of autistic persons on all points of the spectrum, could be a positive force for bettering the lives of autistic persons. But it does not do these things. What the neurodiversity movement tries to do, at its heart, is convince the world that autism is not a disorder. Part of this effort involves demonizing anyone who describes some of the unpleasant truths associated with some cases of autism. This occurs when such unpleasant topics as feces smearing, self aggression or other acts of violence are discussed realistically by parents such as the courageous parents of the Autism Every Day video.

We have experienced these unpleasant truths in our household. Our autistic son, Conor, is a joy, a blessing. The numerous posts on this blog site about Conor present the joyful element of our son. But the reality is that he also can become aggressive, pulling on his mother’s hair suddenly or biting. These are truths, unpleasant truths but truths nonetheless. Our furniture is largely in shambles with legs broken off chairs, mirrors shattered, cabinet and closet doors unhinged, keys removed from computer keyboards. I have experienced an arm coming suddenly around my neck from behind while driving the family car.

Describing such truths is not dehumanizing our son as the neurodiversity authors, would have you believe. It is speaking the truth and describing the facts as they are not as we would wish them to be. It is not a violation of Conor’s human rights to describe him, and his autism disorder, in honest realistic terms. To the contrary, it would be a gross violation of his human rights to disregard the challenges he confronts by virtue of being autistic and failing to take steps to remedy those challenges using interventions judged effective based on the best available evidence.

The neurodiversity movement is proud of those high functioning autistic persons who can write lengthy articles on internet sites, speak to courts and legislatures, and make interesting interesting internet videos. It also likes to embrace and diagnose as autistic historical figures of great intelligence such as Albert Einstein. But the neurodiversity, autism acceptance, movement does not like to talk about lower functioning autistic persons or the very real challenges faced by families who actually care for and live with lower functioning persons. Worse that that, as the Autism Every Day parents, and a host of other parents trying to help their autistic children have discovered, they do not want anyone else to talk about these realities either.

The neurodiversity movement does not represent the views of all autistic persons. It represents the views of SOME autistic persons, some, not all, high functioning autistic persons. These individuals, and the handful of misguided professionals who adopt their point of view, would have you believe that there are no low functioning autistic persons, that it is wrong to even use such terms as high functioning or low functioning. They do not want to acknowledge that some autistic persons are intellectually impaired. They do not want to talk about the autistic persons who actually live in institutions around the world in less than pleasant conditions, including here in New Brunswick Canada.

At its heart neurodiversity is an internet movement based on a group of people who share in common a diagnosis of a medical disorder – autism – but who refuse to accept that autism is a disorder. Neurodiversity is for this reason inherently a contradiction but one that can be very misleading in the view of autism that it presents to the world.

The DSM-IV diagnostic criteria:

# A total of Six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3).

1. qualitative impairment in social interaction, as manifested by at least two of the following:
1. marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
2. failure to develop peer relationships appropriate to development level
3. a lack of spontaneous seeking to share enjoyment, interest, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)
4. lack of social or emotional reciprocity

2. qualitative impairments in communication as manifested by at least one of the following:
1. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alterative modes of communication such as gesture or mine)
2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
3. stereotyped and repetitive use of language or idiosyncratic language
4. lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

3. restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
2. apparently inflexible adherence to specific, nonfunctional routines or rituals
3. stereotypes and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
4. persistent preoccupation with parts of objects

# Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

# The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder

Autism is a different order but it is also very much a disorder. The DSM-IV says so. My life experience with my profoundly autistic 11 year old son confirms for me that fundamental truth.

March 19, 2007 Posted by | applied behavioral analysis, autism disorder, autism every day, DSM-IV, neurodiversity | 3 Comments

Evidence Based Autism Interventions

The expression “evidence based” is often encountered in discussion of autism treatments or interventions. Parents, government officials, professionals and researchers will use the expression when discussing the effectiveness of various interventions in treating or curing autism. A well known article in the Journal of the Australian Medical Association, linked on the sidebar of this blog site, is entitled “Autistic Children Deserve Evidence Based Intervention“. But what does the expression “evidence based” mean and which autism interventions, if any, meet the evidence based standard?

It is important for parents and political decision makers trying to determine what interventions to provide autistic persons to understand the concept of “evidence based” interventions. There have been many quack autism interventions offered both by self promoters and wishful thinkers. Such interventions waste valuable development time of autistic children, waste family and government funds, and in some cases, actually cause direct harm. Unfortunately there have also been those who are opposed to curing or treating autistic persons, those who wish to promote alternative interventions, or who wish to avoid expending public resources to provide treatment, who attack Applied Behavior Analysis (ABA) despite the quality and quantity of research supporting the efficacy of ABA as a health and education intervention for autistic children.

CAIRN, the Canadian Autism Intervention Network, defines “evidence based”:

By evidence-based, we mean the best available information based on scientifically rigorous research that produces consistent findings no matter how many times the study is repeated.

CAIRN also notes that there are substantial differences in the quality of evidence. It lists on its web site the characteristics of studies that provide high quality evidence.

Systematic reviews
A systematic review uses a clear and systematic method of finding and appraising relevant, high quality research studies whose combined results are used to answer a pre-determined question about treatment.

The strength of the systematic review is in its ability to combine data from studies of different populations in different settings to show if a treatment is widely applicable. By pooling data from patients in a number of studies, thus increasing the sample size, a systematic review can increase the reliability of the findings, showing whether a treatment actually works or may be useless or even harmful.

Randomized controlled trials (RCTs)
In RCTs, research subjects are randomly placed in one of two groups. One group receives the intervention that the study has been designed to measure; the other group (known as the control group) does not. The control group may receive a placebo, no treatment, or another therapy. Study participants (and ideally, the researchers) do not know to which group they have been assigned.

RCTs are considered the second strongest level of evidence for the effectiveness of a treatment. The strength of the RCT is that it helps ensure that the two groups under study do not have any important differences between them that could influence whether or not the treatment they receive works.

Controlled clinical trials (CCTs)
In a controlled clinical trial, one group receives a therapy and the other (control group) does not. As in RCTs, the control group may receive a placebo, no treatment, or another therapy. Unlike RCTs, however, the participants are not randomly assigned to each group.

With some populations, or in some situations, it is not possible to randomly assign participants to one group or another. CCTs still use a comparison group and efforts are made to ensure that the two groups do not have serious differences between them that could influence the results of the study.

Multiple and single case studies
In multiple and single case studies, subjects are tested to establish a baseline. They are then given an intervention, after which they are re-tested to determine what change, if any, has occurred.

Sometimes, especially when there is great variability in a condition, or small numbers of people with a condition, it is not possible to conduct research with two groups. In multiple and single case studies, the participants are used as their own comparison when they are given alternating treatments, or a treatment and then no treatment. Although not providing the same strength of evidence as an RCT or CCT, when done rigorously, these studies can yield valuable information about treatments.

In its February 2000 (Rev.) Autism Task Force Report the Maine Administrators of Services for Children with Disabilities (MADSEC) reported the results of its thorough review of the professional literature on educational interventions for autism. The MADSEC Task Force also interviewed leading practicioners of various autism interventions. It concluded that only one intervention met the standard of being an evidence based effective autism intervention – ABA.

• Substantiated as effective based upon the scope and quality of research:
Applied behavior analysis. In addition, applied behavior analysis’ evaluative procedures are effective not only with behaviorally-based interventions, but also for the systematic evaluation of the efficacy of any intervention intended to affect individual learning and behavior. ABA’s emphasis on functional assessment and positive behavioral support will help meet heightened standards of IDEA ‘97. Its emphasis on measurable goals and reliable data collection will substantiate the child’s progress in the event of due process.

……

Conclusions
There is a wealth of validated and peer-reviewed studies supporting the efficacy of ABA methods to improve and sustain socially significant behaviors in every domain, in individuals with autism. Importantly, results reported include “meaningful” outcomes such as increased social skills, communication skills academic performance, and overall cognitive functioning. These reflect clinically-significant quality of life improvements. While studies varied as to the magnitude of gains, all have demonstrated long term retention of gains made. Other major contributions of ABA to the education and treatment of individuals with autism include:

• a large number of empirically-based systematic instruction methods that lead to the
acquisition of skills, and to the decrease/elimination of aberrant behaviors;
• a technology for systematically evaluating the efficacy of interventions intended to affect individual learning and behavior; and
• substantial cost/benefit.
Over 30 years of rigorous research and peer review of applied behavior analysis’ effectiveness for individuals with autism demonstrate ABA has been objectively substantiated as effective based upon the scope and quality of science.

Since the publication of the MADSEC Autism Task Force Report there have been more studies confirming ABA as the most effective autism intervention. In “A comparison of intensive behavior analytic and eclectic treatments for young children with autism” published in Research in Developmental Disabilities, 26, (2005), pp. 359-383, the authors, Jane S. Howard, Coleen R. Sparkman, Howard G. Cohen, Gina Green, Harold Stanislaw reported the results of a non randomized comparison trial with three intervention groups of children with autism spectrum disorders. 29 children received one-on-one intensive behavioral therapy for 25 to 40 hours per week (IBT group); 16 received eclectic therapy (multiple treatment methods) with a teacher to student ratio of 1:1 or 1:2 for 30 hours per week (AP group); and 16 received a non-intensive, eclectic, small group, public early intervention program for 15 hours per week (GP group.) The study’s authors reported that 14 months after initiation of the interventions, the intensive behavioral therapy group scored significantly higher on all measures, with the exception of motor skills, where there was no difference among groups.

Alan Harchik, senior Vice President with the May Institute, has written an excellent article on the topic of evidence based interventions. Mr. Harchik describes evidence based standards and cautions against the use of the many treatments and interventions for autism that do not meet that standard including sensory integration, facilitated communication, auditory integration, chelation and hyperbaric oxygen treatments.

The term evidence-based practice is frequently used in the fields of science and medicine. It refers to procedures that have been tested using scientific research methods and shown to be most likely to produce positive results. This means that objective studies have been conducted using reliable data collection methods, consistent implementation of the treatments and the careful control of the research conditions.

The research findings are then published in professional journals after review by a panel of experts in the field.

Mr. Harchik, like the MADSEC Autism Task Force Report, concludes that ABA is the intervention with the most evidence supporting its effectiveness.

For children with autism, the procedures that have the most evidence supporting their effectiveness are those that use applied behavior analysis. …. applied behavior analysis methods include an assessment of the factors that are impeding learning or maintaining behavior problems, using positive rewards, teaching in small steps, using prompts and guidance, and collecting data to monitor progress.

The studies and expertise which provide evidence of the efficacy of ABA in autism intervention have not persuaded some who oppose the use of ABA interventions with autistic persons. Some will continue to insist on an unattainable standard being met before they will acknowledge the efficacy of ABA. For others though, for parents, professionals and government decision makers seeking to help autistic children now ABA, their only agenda is to find out what works, what really works, based on the best available evidence. To date, ABA is the only intervention for which claims of efficacy meet the high quality evidence based standard. That is why parents and sincere autism advocates try to obtain passage of legislation in Canada and the United States to ensure the availability of ABA treatment for autistic children.

March 10, 2007 Posted by | applied behavioral analysis, autism, autism interventions, evidence based, Harchik, MADSEC, May Institute | 6 Comments