It took about five years to establish a good working relationship with school personnel, who speak a different language from physicians, he said. Another obstacle was the negative experiences that the school staff had when sending children to Pittsburgh for psychiatric evaluations before his arrival.
But even that has become less of an option as the entire western half of the state has seen a decline in the availability of child psychiatric services, he said. "Even sending a kid into Pittsburgh for an evaluation has become so much harder."
When Kashurba first began conducting autism evaluations, he saw a number of significantly autistic 8- and 9-year-old children who had never seen a child psychiatrist. Instead, they had basically traveled two and a half hours into Pittsburgh just to see a social worker, he said.
Now that his program has cleared the backlog of older patients, Kashurba is able to assess children for autism at ages 3 and 4.
The region Kashurba serves includes the town of Shanksville, site of the Flight 93 crash on Sept. 11, 2001. Kashurba volunteered his services to meet with victims' families at the crash site. "Had I not gone, there wouldn't have been anyone there working with the families who had been trained at all with children."
Kashurba has written two books on the subject--Courage After the Crash: Flight 93 Aftermath and Quiet Courage, which will be released this summer.
The long-term effects of Sept. 11 on children in the four-county area were minimal, Kashurba said, although there was an intensification of pre-existing difficulties at the time of the attacks.
A series of tornadoes that hit the region in 1998 provoked a much stronger reaction. The tornadoes were completely unexpected in the mountain region. The first one killed a 13-year-old girl. The next night, a stepfather and child died as a result of tornado damage to their home. And two days after the first storm, two more tornadoes struck, damaging 400 buildings as people sat in their basements listening to the radio for updates.