Why No Increase?

With such clear data, why would anyone think there is no increase in autism?

Critic of the "autism epidemic" point of view centers around several issues. At the basis of these issues lies diagnosis substitution. An autistic person would not have been diagnosed with autism in the 17th century because Kanner first described autism in 1943. If there were autistic people prior to 1943 they would have been diagnosed differently. Most likely they would be considered developmentally delayed or mentally retarded. Maybe Kanner just described as a separate condition what was earlier considered a subset of mental retardation and/or developmental delays. As his definition became better known and accepted by other physicians and psychiatrists an increasing number of people were diagnosed as autistic.

Diagnosis substitution has been driven to a large degree by broadening of diagnostic criteria. Over the years there have been several revisions of the autism definition, each time broadening the criteria to include more cases. One could actually view Kanner's paper as the first broadening of the autism definition. Every time the autism definition is expanded diagnosis substitution increases.

Another frequently raised point is that in recent years the societal stigma of having autism has been significantly reduced and many services have been offered to autistic individuals. This has provided incentives for doctors to give autism diagnosis to their patients, thus making them eligible for services. Again, this results in wider diagnosis substitution.

Besides diagnosis substritution, it is possible that, as criteria and awareness of autism have expanded, many high-functioning autistics who would not have been diagnosed with any disability in times past are now receiving an autism diagnosis.

All these trends are undeniable. But are the effects sufficient to fully explain the increase in autism diagnosis? This issue is controversial and very important. If there is an actual significant increase in autism, then there is likely an environmental cause. Research efforts should be focused on finding this cause or causes. A significant increase in recent years would point to some assault that has been introduced and/or significantly increased recently, such as pesticides, immunizations, environmental polution, etc. If, on the other hand, there isn't a real increase in autism there would be little reason to focus significant research efforts on recent environmental changes.

With this in mind, it is well worth it to examine the available studies on autism prevalence.

Why an Increase?

Why would anybody think there might be an increase in autism?

When autism was first described by Dr. Kanner, he said that this is an extremely rare disorder. At the time autism prevalence was estimated at about 1 in 10,000. The most recent CDC estimates are about 1 in 150. If the word 'autism' still retains its original meaning and these estimates are even remotely accurate than there is a huge increse in autism. Moreover, there have been a number estimates inbetween those two and one may notice that estimates of autism prevalence have steadily increased over time.

Also, the number of children enrolled in special education in California with a diagnosis of autism has been on a steady increase over the last 17 years, ever since 'autism' was introduced as a separate cathegory by the Department of Developmental Services in 1991.

Is Autism Rising

A question of some debate is whether autism is on the rise. Autism was first described by Leo Kanner in 1943, when he wrote about 11 children born in the 1930's who were “markedly and uniquely different from anything described so far.” Since then autism diagnoses have constantly risen through the years, reaching to the point where 1 in 150 children born develop some form of ASD.

Is autism really on the rise or is the constant rise in autism diagnoses due solely to awareness and broadening the defintion of autism? Did Kanner write about something that was common, yet nobody had bothered to describe, or did he really describe a new disease? Were autistics alweays there, but just called by another name before? You can find opinions on both sides of the fence.

Prevalence of Autism

The CDC estimates that 1 in every 150 children has autism spectrum disorder (ASD). The CDC based this figure on a study released in 2007 . The study looked at eight year old children across 14 study sites. At six sites the children were born in 1992 and evaluated in 2000, at the other eight sites the children were born in 1994 and evaluated in 2002.

Another US study published in 2003 estimated autism prevalence at 3.4 per 1000 (95% confidence interval [CI], 3.2-3.6), which is about 1 in 294.

What is Autism?

Let's try figure out what we are talking about...

The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision 2000 (DSM IV-TR) is a publication of the American Psychiatric Association and contains the most widely used definition of autism. It defines autism entirely in terms of behaviors and abilities. Here is the full definition courtesy of the Center for Disease Control (CDC).

Diagnostic Criteria for 299.00 Autistic Disorder

What a mouthful!

Wikipedia

When researching a topic one of the first things I like to do is take a look at Wikipedia. There is a lot of stuff there and lots of links. When a topic is riddled with controversy, like autism is, Wikipedia provides differing points of view. Going deeper in the "discussion" page one can see further opinions, discussions, arguments. Then I follow the links and related topics.

All this is useful even when I am quite familiar with the topic, like with autism. I frequently find things I am not aware of, but also, more importantly, I find well documented arguments pro and con and get to challenge my own prejudice and preconception.

So here it is...
http://en.wikipedia.org/wiki/Autism

Autism

Everyone with even marginal experience knows that facing autism can be quite frustrating. There are some daily challenges when caring for a loved one whose primary interests appear to be focused on discovering novel methods to stir trouble. Spilling oil on the carpet, flooding the kitchen, breaking glass and furniture, tearing books and documents, screaming and kicking the walls in ungodly hours... Are you keeping your cool? Where is your sense of humor?

This may seem like plenty, but there is a much bigger mess that needs to be sorted out, a mess bigger than anything our beloved can create, one that extends well beyond our human understanding. Yes, I am talking about autism research. Thousands of frustrated parents each with their own theory about autism etiology and threatment, high profile government researchers proclaiming autism an idiopathy and refusing to listen to anyone who claims to know anything, chelation, genetic links, vaccinations, swimming with dolphins, mercury, applied behavioral analysis (ABA), gluten free/casein free/specific carbohydrate diet, enzymes, supplements, speech therapy, special masters, expert witnesses, water filters, safe rooms, B-12 shots, calcium, tetrahydrofurfuryl disulfide (TTFD), mitochondria, 2,3-Dimercapto-1-propanesulfonic acid (DMPS)...

So where do we start?