Top post of 2017- why the increase in autism?

You’ve heard and read much about autism recently. The top new TV drama this season , The Good Doctor, has a major character with autism (although the actor himself is not).

This illustrates the interest in autism spectrum disorders, and the controversy. We are not certain of the cause, and wonder why the condition is diagnosed more frequently.

Perhaps that explains why this was the most viewed post on this blog in 2017.

Like other physicians and families of people with autism, I puzzle over the increased number of children and adults diagnosed with autism. Most of us have theories about why we now believe 1 in 68 children have autism spectrum disorders.

People point out that “when they were children” they never knew of anyone with autism. There are those who are absolutely convinced that the increased numbers of autism followed the introduction of the measles-mumps-rubella vaccine, MMR. Others implicate genetics, environmental toxins, diet, and intrauterine brain trauma.

I found an article that offers a sound, well thought out and expressed explanation. It contains several points that I have identified and some I had not.

The article was published in Spectrum whose commitment is “to provide accurate and objective coverage of autism research.” Spectrum is funded by the Simons Foundation Autism Research Initiative. Senior News Writer Jessica Wright, Ph.D. in biological sciences from Stanford University, wrote the report. (Scientific American also published the article by permission.)

In the article, Dr.Wright concludes,

“The bulk of the increase (in autism rates) stems from a growing awareness of autism and changes to the condition’s diagnostic criteria.”

First , let’s consider some terminology. Prevalence is an estimate of how common a disease or condition is in a particular population of people at any given time.

So the prevalence of autism in children would be

the number of children identified as autistic at any given time

divided by  the total number of children alive at that time .

The currently accepted rate of autism is 1 in 68 children, or 1.4 %.

So  autism prevalence depends on children being correctly identified as autistic. At any given time, some autistic children may not be identified, and some may be  incorrectly identified.

We do not have any totally objective tests available for autism yet. There is no blood test, scan, culture, imaging study, DNA test, or  monitor to definitely conclude that autism is or is not present.

The definition of and criteria for autism have changed substantially since “infantile autism” was first identified by Leo Kanner over 70 years ago. Since 1980, the diagnosis is based on applying the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). In the most recent version, DSM-5, released in 2013, autism, Asperger syndrome, and pervasive developmental disorder, formerly separate, are now a single diagnosis.

 

 

Autism Spectrum Disorder is characterized by

• Persistent deficits in social communication and social interaction across multiple contexts
• Restricted, repetitive patterns of behavior, interests, or activities
• Symptoms must be present in the early developmental period (But may not yet be fully expressed or may be modified by learned behavior in later life)
• Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
• These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.

 

 

At this link you may read the full detailed criteria from DSM-5

Diagnostic Criteria for 299.00 Autism Spectrum Disorder

When the diagnostic criteria for other diseases change, the prevalence also changes. Examples include diabetes, high cholesterol, high blood pressure, migraine, obesity, depression , even some cancers. So autism is not unique in this regard.

The currently accepted rate of autism, 1 in 68, comes from the Autism and Developmental Disabilities Monitoring Network, established by the CDC in 2000. Children are identified by reviewing health and school records of 8 year olds in selected counties. So possibly some children get missed, and some assigned incorrectly.

Another major milestone in autism awareness occurred in 1991 when the U.S. Department of Education ruled that autistic children qualify for special education services.

Parents of children with developmental and intellectual disabilities  have an incentive to secure accurate diagnosis, to qualify their child for services they otherwise might not  have access to.

Since 2006, the American Academy of Pediatrics recommends routine screening of all children for autism at 18 and 24 months old. Many physicians, psychologists, and therapists believe early intervention improves these children’s chances to do well intellectually and socially.

If we could go back and review records of children 10, 20, or 30 years ago, and apply current diagnostic criteria, would we find less autism than we do today? Perhaps. But such records would likely reflect the understanding of autism at the time, so might still fail to recognize autism, even when present by today’s standards.

The apparent increased number of children with autism seems alarming-some call it an epidemic. It may represent our increased awareness, recognition, and knowledge about this disorder. And while this increase should raise concern, it can lead to increased research, treatment options, and more effective care for autistic persons.

Here is a link to the original article

Autism Rates in the United States Explained

How The Good Doctor became such a hit

The premise is simple: Shaun Murphy, played by Highmore, is an autistic surgeon with savant syndrome. His stream of consciousness speaks the language of anatomy, and when the show’s particularly keen on calling attention to his genius, organs and veins and glands float above his head like illustrations ripped from a med-school textbook. “He’s not Rain Man,” says his main advocate at the prestigious St Bonaventure hospital in an attempt to convince the board that Murphy is hirable and high-functioning. To those in the autism community, the show has deftly done just that. “The Good Doctor does a fine job of navigating this razor’s edge,” wrote Kerry Magro on the website Autism Speaks, noting that it shows “several characteristics that can accompany an autism diagnosis such as social awkwardness, lack of eye contact, playing with his hands during stressful situations”. He adds: “Freddie’s take will resonate with many in the community.”

Jake Nevins, The Guardian

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