education & mortality (& being the parent of an autistic child)

Prior research has uncovered a large and positive correlation between education and health. This paper examines whether education has a causal impact on health.

[snip]

This paper has shown that there is a large causal effect of education on mortality. While GLS estimates suggest that an additional year of education lowers the probability of dying in the next 10 years by approximately 1.3 percentage points, my results ... show that the effect is perhaps much larger: at least 3.6 percentage points. Moreover there is a direct effect of compulsory schooling laws on mortality during adulthood: one more year of compulsory schooling decreased mortality after age 35 by about 3%.

[snip]

To better understand the impact of education, I calculate how this effect translates into life expectancy gains. I find that in 1960, one more year of education increased life expectancy at age 35 by as much as 1.7 years (using the OLS estimate). This is a very large increase.

[snip]

This evidence that education increases life expectancy implies that the returns to education, measured only in terms of earnings increases, substantially underestimate the true returns to education.

The Relationship Between Education and Adult Mortality in the United States
Adriana Lleras-Muney
January 2004

Reading The Race Between Education and Technology has led me to think about the relationship between education and being the parent of autistic kids.

Jimmy is 21. When he was diagnosed, no one knew anything about using meds in autism, and everyone was against it. Parents were horrified by the idea, and psychiatrists in Los Angeles routinely told us there were no medications that could treat the "core symptoms" of autism. I remember going to all the parent meetings & hearing that: can't treat the core symptoms of autism.

One shrink in particular ticked me off. I heard him speak in someone's living room. There was nothing medicine could do, he said confidently; the core symptoms were untreatable. News flash.

I didn't like him. I didn't like the cowboy boots he was wearing, I didn't like his twitchy manner, and I didn't like the way he slouched in his chair. I especially didn't like his air of certainty, and I was appalled by the fact that he appeared to consider himself cool. If you're going to tell me there's no hope, don't be cool while you're doing it.

How did this "core symptoms" business make sense, anyway, I wanted to know. Granting that severe mood swings and 4-hour tantrums aren't core symptoms of autism, wouldn't it be a good thing for a child not to have 4-hour tantrums?

Ditto for being unable to sleep more than 4 to 8 hours a night at an age where other kids sleep 12. Yes, sure, raging insomnia isn't a core symptom of autism, but so what? Is raging insomnia good for a 4-year old with autism?

Amazingly, I once had a doctor tell me that raging insomnia was perfectly fine for autistic kids. "These children don't need a lot of sleep," he said.

I thought that was a crock.

I was right. I was so right that in 4 years' time the twitchy psychiatrist in the cowboy boots, who had become Jimmy's doctor when our insurance stopped covering the Encino psychiatrist we'd been seeing, did a fantastic job treating Jimmy with meds.

His one truly brilliant move, when we came to his office panicked because a year of Risperdal-created peace was unraveling, was to say to us, "I'm all out of tricks, my black bag is empty. But sometimes just getting more sleep can help."

He prescribed trazodone and Jimmy had a breakthrough: in mood, in behavior, in functioning. And in sleep. Sometimes a twitchy guy wearing cowboy boots is your kid's future best friend.

That was our second medical breakthrough.

Our first had come the year before, when I was pregnant with the twins and Ivar Lovaas had told Ed we needed to place Jimmy outside the home. Jimmy was 7 years old. "You're going to have two other children to think of," Ivar said. "You have to consider your whole family." He wasn't alone in this view. Jimmy's school principal dropped broad hints that the time had come, and our SPED attorney asked if we wanted to request a residential school.

My therapist asked me, point blank, "How would you feel if Jimmy killed one of the babies?"

"Jimmy isn't going to kill one of the babies," I said. When I left her office, I called my best friend from the pay phone in the hall. "Are my friends saying Jimmy will hurt the babies?" I asked. "Are you all afraid to tell me?"

Her voice was so gentle and kind when she answered. I get tears in my eyes writing this now.

"No," she said. "No one is saying that. Everyone is incredibly worried how you're going to manage Jimmy and two babies. But no one is saying Jimmy will hurt the babies."

I never spoke to my therapist again.

Things got worse before they got better. The Northridge earthquake happened in February just after we'd begun construction on an extra bedroom; the house was a shambles and we had construction workers everywhere -- construction workers who were feuding with each other on site, to boot. The pregnancy had been high risk to start and within a few months most of the bad things that can happen to a high-risk pregnancy did happen. By the end of the 29th week I was in labor and in the hospital mainlining magnesium sulfate. We were facing the possibility of having three disabled children to care for instead of just Jimmy.

We had one person left to turn to. Our doctor, the one in Encino.

That doctor had told us there was a new drug for schizophrenia coming on the market that he wanted to try with Jimmy. Risperdal. It was different from the old antipsychotics, he said. By the time Ed saw him again, with me in the hospital and Jimmy out of control at home, Risperdal was available and the sales reps had made their rounds. Our doctor ransacked his office, pulling out every sample packet he could find and handing them to Ed, who stuffed his pockets full and carried the rest out in his hands. He drove straight to Osco's to fill the prescription before going home to Jimmy and my mother.

The Risperdal worked. With his first dose, Jimmy calmed, the tantrums dropped to nothing, and for the first time in his life he had a bedtime. Ed could read him a story and tuck him in bed and he stayed there and he slept.

Later on I told this story to one of the founders of the National Alliance for Autism Research, who was himself a psychiatrist and the father of an autistic child. He frowned and looked puzzled for a moment, then said, "Jimmy had to have been one of the first children in the country to take Risperdal."

He was.

Risperdal is a tough drug to take; it's nothing to fool around with. It is also a miracle drug, or was for us. On October 6, 2006 it became the first drug to be approved for the treatment of "irritability associated with autism." I believe that Risperdal, along with the other atypical antipsychotics, has produced a new generation of young men and women Jimmy's age who are living in the community instead of in back wards, in restraints, which is where Jimmy was headed.

Claudia Goldin and Lawrence Katz's observation that educated workers are early adopters has stayed with me. With autism, Ed and I have been early adopters.

Being an early adopter in the realm of psychotropic medications administered to your 4-year old is different from being an early adopter of an iPhone. We knew no one who was using meds, and we knew many who thought we were crazy or worse.

To be an early adopter with the big things, you have to be unshakably confident in your ability to listen, read, and think. You probably have to be as confident as the shrink in the cowboy boots, who turned out to be confident for a reason: he was good at his job. He didn't know what he was talking about with the core symptoms business; that was malarkey. But he could look at a child, talk to the parents, prescribe a medication off-label, and make it work. He was an early adopter, too.

Risperdal saved Jimmy's life. When Jimmy was 4, the social worker at the Regional Center told me, "I can see that you and Jimmy have a very close relationship. But in a few years, you will come to me for a placement."

I didn't, but she wasn't wrong. Three years later, the experts in our lives agreed that it was time.

That Jimmy's life turned out so differently is a tribute to education: to the education of the psychiatrists we've worked with for nearly 20 years, to the education of the teachers and behavior analysts who taught Jimmy and us, to the education of the research scientists in their labs, and, not least, to the many years of education Ed and I had when we were young.

Being educated ourselves, we were able, often enough, to know a good idea when we heard it.

We could spot malarkey, too.