Autism Rate continue to Climb and Climb and Climb

The likelihood of a child’s being given a diagnosis of autism (ASD), Asperger's Syndrome or a related disorder seems to have increased more than 20 percent from 2006 to 2008. The New York Times and other major papers have proclaimed a definite rise.

Click here to view the article from the NYT
http://www.nytimes.com/2012/03/30/health/rate-of-autism-diagnoses-has-climbed-study-finds.html

Reading the New York Times we see there is a new report from the US Center for Disease Control (CDC) which estimates that in 2008 one child in 88 received one of these diagnoses (by the age of 8), known as autism spectrum disorders or ASD, compared with about one in 110 diagnosed with ASD two years earlier. Does this indicate that we are seeing an epidemic of autism, as some have speculated, or is the issue one of changes in the way we diagnose autism, or that we (doctor, teachers, parents) now pay more attention to the symptoms and therefore notice and then diagnose more children? At this point, it's not clear.

As some have suggested, one possibility is that we are seeing the result of better detection rather than a real surge in autism. However, there are some striking parts of this new CDC study that again makes us wonder if there isn't really an increase in the number of cases.

One report notes, "The rate of autism increased by more than 45% from 2002 to 2008 in numerous sites. It was a larger and more consistent increase than from 2002 to 2006. The increase was also very uneven in terms of geography, gender, race and ethnicity. Some sites had nearly five times as many children with autism as others. In several sites, almost 1 in 33 8-year-old boys were diagnosed with autism. This seems difficult to believe, particularly when these sites had smaller samples and children with less severe intellectual disabilities. One wonders if some sites became part of the study because of a long-term commitment to autism services, and this had drawn certain families to live nearby, resulting in an increase in the frequency of diagnoses made by local medical centers or educational programs." In other words, people may move closer to some centres that study autism and therefore the local rates are, indeed, higher.

Also, since the children didn't just meet the CDC study criteria for autistic characteristics -- 80% of them had autistic diagnosis from community physicians -- it may be that there is truly a higher rate of autism. Granted, the children were not actually seen by CDC researchers, so it's possible that the methods of diagnosis varied among the sites. All of these variations make it difficult to really understand this data. Apples and oranges.

So, what are the implications of this new study?
The CDC researchers are aware that it's critical to identify the sources of variability in their data. For example, why were nearly twice as many children diagnosed with autism in Utah than in Colorado or Arizona? If the rates are really increasing, does it mean that many more children, particularly those from ethnic or racial minorities who are often missed, could have autism and we just don't know yet? If we do a better job of identifying children with autism, the rate will certainly continue to increase. How do we address this issue, which is not unique to autism?

Thomas Insel, director of the National Institute of Mental Health, commented that the most useful approach right now is to assume that there is an increase in autism and try to figure out why this is happening. He says, "Regardless of all the unanswered questions, we should keep in mind that autism is a common condition. More children need autism services than ever before. We need cost-effective ways to identify the disorder at early ages, provide adequate support and work with affected families to help their children transition to adulthood."

"For families concerned that their child might have autism, it's important to be persistent in seeking help. The study suggests that children with autism in some parts of the country are much more likely to be recognized than in other parts, so seek the best resources possible and do not give up until you are sure. It may be that your child does not have autism since the disorder overlaps with various other common conditions such as delayed language ability and attention deficit disorder. Far more children don't have autism than do."

So, lets sum this up:
That is apparently a relative increase of 23% from a previous analysis of data from the same network of clinics and doctors for 2006, when the estimated prevalence was one out of 111 children, and a 73% relative increase from 2002, according to a surveillance summary in Morbidity and Mortality Weekly Report.

Understanding this is tricky because of a lack of objective diagnostic markers and changes in clinical definitions over time, so it's unknown how much of the increase is real and how much is related to changing diagnostic criteria and better identification of cases. But here is the important point: If these children really meet the diagnostic criteria for autism spectrum disorder, new, previously missed, finally noticed doesn't matter as much as: Are we funding research properly? At a rate that is commiserate with the seriousness of this disorder? Have we wasted enough money, time, research effort on false theories like autism and vaccines already? Is it time to start a "war on autism" like the war on cancer? Time to devote a lot more money to both treatment and research into prevention? Those questions can be answered, and the answer is yes.