Continued Rise In Autism Diagnoses Puzzles Researchers, Galvanizes Advocates

sciencehabit (1205606) writes "The Centers for Disease Control and Prevention (CDC) has raised eyebrows, and concern among current and prospective parents, with a new report documenting that the rate of autism spectrum disorder diagnosis in the United States jumped 30% between 2008 and 2010, from one in 88 to one in 68 children. CDC officials don't know, however, whether the startling increase is due to skyrocketing rates of the disorder or more sensitive screening, or a combination of both."

Comments

Medicalizing Normality

[Anonymous Coward]

'Nuff Said

Re:Medicalizing Normality

[MitchDev]

It's just a repeat of the "ADD" craze the medical industry was in in the 80's and 90's to make doctors feel needed and important....

Re:Medicalizing Normality

[Pope]

Have you ever considered that perhaps Autism is an evolution of humans, rather than a thing which will "fuck" us?

LMAO, you don't know how evolution works, do you? What possible advantage could autism provide, when it renders most afflicted persons unsociable and awkward and therefore highly unlikely to pass on their genes?

Re:Medicalizing Normality

[s0nicfreak]

Society is changing to interact less in person, and more via electronics - which Autistic people are great at. Having a teenage son (and by extension seeing many different teenagers) I have seen that you don't have to be unawkward and sociable in person to get laid anymore. Even if the "normal" people pay you no attention, the other Autistic people - where there are plenty of - will assist you in passing on your genes.

Re:Medicalizing Normality

[canadian_right]

You've never actually met an autistic person have you? It is NOT an advantage in 99.99999% of cases, A few people with mild cases can live normal lives, but this is the exception. Most autistic people cannot live on their own and require close supervision 24x7. Most people, even saintly social workers, find it extremely unrewarding, frustrating, and generally unbearable working with autistic people.

Autism is a horrible affliction.

Re:Medicalizing Normality

[funwithBSD]

My son is autistic too.

With the right combination of Physical Therapy, Speech therapy, and Occupation Therapy over the last 7 years, he is almost indistinguishable from a "normal" person. He is not that much different from your average geeky kid, except his short term memory is like a database with broken indexing: it is all there, but he has to really work to get it out. If you supply a prompt, the data floods back out of him at a surprising rate.

So far, his only real social setback is he has NO IDEA that all the girls around him adore him. Kid is putting out some sort of weapons grade pheromone or something.

He came home the other day with some cool looking knotting thing going on. Asked him about it, turns out the girl who is the top of the social pecking order in his class saw his shoe untied. She offered to tie it for him at lunch, spent half of lunch break redoing the lacing.

I don't think he will have any problems passing on his genes.

 

Re:Medicalizing Normality

[BobMcD]

My youngest son has high-functioning autism with pdd. From my point of view, you're both right and wrong (in that extremely insensitive way only an ignorant person can be.) So let me reflect.

You're right - there is a 'craze'. It involves things like throwing Risperdal and/or non-gluten-casein diets at a problem that science can't even define, let alone treat. Jenny McArthy's book, all that crap. It is crap, you're right about that. It is the same as all infant science - as much voodoo as fact. But that goes for a lot of medicine these days, so let's not judge too harshly.

You're wrong (in a fuck-you-generating way) that this is 'just' a craze. My son is a very different type of human. In fact this is how we break in new care givers: "Imagine a space craft landed and dropped off one of their children. Everything he does is normal on his home planet, and most of the things we do are weird and strange to him. That's Scott."

He can't really relate to people in a natural way. Eye contact is poison. He mixes up the concepts of 'love' and 'need' (he'll be the first to tell you he 'loves to fart', for example.) He'll probably never have a 'normal job', but could work in a specialized environment, etc.

There are upsides, too. Some of them are basically superpowers. For example, if he saw a calendar at any time during his life, he remembers it forever. So you can ask him, 'what was the Wednesday before April 7th, 2006' and he'll tell you. I have no idea how useful this would be to anyone, but it's still pretty remarkable. His circadian rhythms are pretty much infallible. Stuff like that.

In short, he's unique enough to have a 'thing' that deserves a name. The existence of the 'craze' doesn't invalidate the 'thing'.

It isn't all bad

really? really.

[Anonymous Coward]

about a century and a half ago, nobody ever heard about autism.
you wouldn't be diagnosed an autist, but simply made to stand in a corner of the class with a dunce cap a lot.
i can picture the headlines.

autism discovered!

sudden surge in number of autists baffles scientists!

as we get better at diagnosing conditions like this, naturally there will be a rise in the number of positive diagnoses.

Re:really? really.

[bickerdyke]

Plus a number of parents that can't accept that their precious offspring simply may be plain stupid or lazy as any other kid.

There HAS to be a reason and there HAS to be someone or something responsible for Li'l Joe standing in the corner with the dunce cap so often.

And I guess that still leaves a bit of wiggle room for an actual increase of people ending up somewhere in the autistic spectrum.

Re:really? really.

[king neckbeard]

Actually, the article states about half of those diagnosed have average or above average intelligence. Thus, autism is becoming less and less about intelligence and more about just having different behavior. I think this will likely be a great thing, as it will help separate the conflation of autism with mental retardation. This will benefit everyone across the spectrum of intelligence, and along the spectrum of what we consider severity for autism.

Re:really? really.

[jones_supa]

And of course, the Linux kernel.

Re:really? really.

[Jason Levine]

Actually, as someone likely on the autism spectrum* - albeit high functioning, I find it easier to communicate via social networking (and online in general) than face-to-face. With face-to-face, there are problems like needing to think of the appropriate thing to say in the appropriate manner, keeping appropriate levels of eye contact, getting the tone right, blocking out distractions like other conversations, and doing all of this on-the-fly in a short enough period of time. Often I have exactly the right words in my head, but they come out of my mouth all wrong (if they come out at all). With online communication, I can type out my reply, correct it five times to hone my message before sending it. (Like I've done with this one.) If anything, I've found that online communication has helped me with face-to-face communication, not "increased my autism."

* My son was diagnosed with Asperger's Syndrome and everything that I read seems to describe me as well. I could seek a diagnosis but it would spend money we don't have and wouldn't help my son out. So I'm comfortable being "likely" instead of "definitely."

Re:really? really.

[Jason Levine]

^^^ This is exactly true. The problem that many on the autistic spectrum face is that they can't figure out how to communicate their thoughts with neurotypical people or they get overwhelmed by sensory input. In the case of the latter, imagine trying to give a speech while five speakers play different genres of music turned up to 11, with spotlights aimed right at your eyes, and a team of people poking you with sticks. Now imagine that there was someone in the audience for whom the music and lights appeared normal. How articulate would you appear to this person? Probably not very. Autistic people get written off as "dumb" when the real description is often "has a hard time communicating."

Re:really? really.

[ColdWetDog]

You realize that 'normal' people invariably have symptoms or findings found in syndromes or diseases. The discovery of which prompts the 'second year medical student syndrome'. At least in the US, the second year of medical school is when you start studying the pathology of disease and learn about all of these funny named syndromes and problems. Invariably at least one or two resonates with the reader and they feel instantly afflicted. This prompts further study (which is good) and further worry (which isn't).

What you described is pretty much everyone who doesn't go on to be a used car salesman or a politician. Figuring out the ins and outs of social contact is hard for most humans. People afflicted with autism / aspbergers are really hard stopped to the edge of human contact. Yes, at a molecular level, some of us who don't deal with the social graces as well as others probably have some similarities, but pretty much all of health and disease lies along a continuum, We often make fairly arbitrary distinctions because it helps pigeon hole things and humans like to do that... But it's not always representative of the issue.

Shifting thresholds

[Rosco P. Coltrane]

I suspect a lot of diagnoses concern borderline cases, that would previously not have been counted as verified autism - so before, people would be classified as "odd" or "geeky" but not as someone who carries a mental disability.

The same thing happened with depression. In the old days, depression was virtually unheard of, aside from extreme cases of people constantly trying to take their own lives. Nowadays, everybody and their dog gets depressed at some point during the year, and prescribed medicine.

Re:Shifting thresholds

[Chrisq]

Nowadays, everybody and their dog gets depressed at some point during the year, and prescribed medicine.

Sadly this is literally true

Re:Shifting thresholds

[wonkey_monkey]

Maybe he's just sad that dogs get sad.

Re:Shifting thresholds

[gtall]

Really? Ever see someone in their manic mode of manic depression? I have a sister with this as well as schizophrenia because many mental disorders rarely come alone, it is something like a smorgasbord. Anyhow, one evening she took exception to the wall-to-wall carpeting in Ma's bedroom while Ma was in the hospital. She ripped up that carpeting in the bedroom and an adjacent room, moving several pieces of large furniture out of the way to do it. I asked her how long it took, it took a few hours in the evening and a few the following morning.

She ripped up the carpeting with her bare hands. That's what can happen when she doesn't take her meds. And that was during a manic episode, the schizophrenic episodes are stranger.

Unless you've lived with someone with mental illness, you don't know squat about it.

Galvanises?

[Sockatume]

At last, the real culprit is revealed: zinc.

Autism is the new ADD

[korbulon]

Not saying that all or even most of the diagnoses of autism are false positives, but when you're living in a world where human communities are dwindling and become more insular - so there is less direct social engagement, extended families are spread across continents - so this core social unit is less dynamic and extensive, and people spend more and more time in front of screens - at work and at home, this sort of result is not overly surprising. Shit, when did the first iPhone come out? Mid 2007? Coincidence? iThink not.

Increased screening sensitivity is probably playing a big factor as well: "Tommy seems rather introverted and shuns the company of others. He also throws a huge tantrum when we take away the tablet with the toons on it. Probably autism." I'm not saying this is due to negligent parenting, but when there is an obvious diagnosis that fits the symptoms, why look any further? Again, these are the marginal cases which are sufficiently prevalent to cause this spike.

Education funding and excessive medicallisation

[NoNeeeed]

Part of the problem in the UK (so may not be the same in the US) is that there is additional funding and support for kids with diagnoses like ASDs so there is a big incentive for schools and parents to push for it. It's driving a whole approach of medicalising behaviour. Kids who in the past would have been simply regarded as a bit unusual and who a teacher would have had to just cope with are now being given medical diagnoses and possibly additional help.

As discussed in the article what would be interesting to see is more detail on the distribution of ASD diagnoses, in terms of where they sit on the spectrum. If there is an increase the diagnosis of severe autism (the kids who would reasonably have been diagnose as autistic 30 years ago) then that would suggest that there is some environmental factor at work. If, on the other hand it's mostly high functioning and borderline then it seems likely to be mostly down to diagnosis.

While I'm very much in favour of education being better able to deal with kids' differences, I'm not sure medicalising it is the way to go.

Re:Education funding and excessive medicallisation

[Anonymous Coward]

My grandparents clearly had autism. It was never formally diagnosed. They had all sorts of interesting personality disorders (DSM!) and unhealthy destructive relationships.

My parents clearly had autism. It was never formally diagnosed. They have all sorts of interesting personality disorders (DSM) and unhealthy destructive relationships.

I clearly have autism. It was never formally diagnosed. My parents dealt with it by physical punishment. They hit me with wooden sticks so they wouldn't hurt their hands. I grew up really fucked up. Imagine being randomly beaten for reasons you do not and can not understand. I spent 2 decades clinically depressed, actively trying to kill myself. I know what arsenic tastes like. I know what it's like to hold a knife to my wrist, a gun to my head, and want, more than anything, to pull the trigger and end my pain and suffering. Sometimes you hold on for just another day. Sometimes for only a few more seconds of life. You know how a child's mind works? I used to wonder if I had already died, and already gone to hell, as I couldn't imagine anything worse.

I got out of that. I got help. I spent almost another 20 years in psychotherapy, putting the pieces of my mind back together again. Unlearning the self-destructive behaviors I had unconsciously accepted. Not an easy thing.

Today, I'm in my fifties. Today, my children have autism. It has been diagnosed. I have them seeing some of the best doctors in the country, right on the leading (bleeding) edge of medicine.

Today we understand how layers of the brain's neural structure do not develop properly in autistic kids. How autism has many causes. Some kids will respond to gluten free diets. Others to dairy free diets. There are blood tests that can pick up on the antigens, telling us which kids can be helped by such alterations. It's known that their gut (intestines) are leaking proteins, causing the immune reaction picked up by the blood tests. It's known that these proteins can bind to neural receptor sites, and how they can act exactly like narcotics.

Today it's known how still others kids have problems with nuts, with artificial sweeteners, or with artificial colors. There are a many dietary problems, and that's just the tip of the iceberg. Other kids have difficulties with heavy metals. Others have, well, the list of causes here goes on and on and on. Autism is a catch-all disease, describing symptoms with a great number of underlying causative factors.

Bottom line here is that there is a lot we can do to help these kids without fucking them up for life with depression or psychosis through abuse. If you don't deal with their problems, it is abuse. We assume control they do not possess. They can develop into great engineers, doctors, whatever. They're bright kids. Just different. They don't have to become monsters. We don't have to turn them into monsters!

Re:Education funding and excessive medicallisation

[s0nicfreak]

Actually, the social and language use issues are gauged purely through in-person interaction; many Autistic people are adept at social interaction and language use via electronic means.

There is a severely autistic girl who was thought to be completely incapable of social interaction and language use... until she went over to a computer and starting typing on it. Basically she was seen as severaly retarded based on in-person interaction, but with the use of electronics to communicate, she is now in gifted classes http://carlysvoice.com/home/ab...

That's a bit simplistic...

[Two99Point80]

There is much, much more to the process of professional evaluation and diagnosis than what you describe. The process is a whole lot more rigorous than idle speculation.

Re:That's a bit simplistic...

[AthanasiusKircher]

There is much, much more to the process of professional evaluation and diagnosis than what you describe. The process is a whole lot more rigorous than idle speculation.

Sure it is. But that doesn't mean there can't be other things going on here.

Let me tell you a little story.

About a decade ago, I taught high school for a few years. First, I spent a few years in public schools, mostly middle class or lower middle class communities. The percentage of students I had who had diagnoses (mostly cognitive disorders or deficits) which would get classroom accommodations like additional time on tests, etc.? About 1 or 2%. A REALLY small number.

Then, the last year I taught high school, I taught in an elite private school which was one of those "feeder schools" to Ivy League colleges and such. The percentage of students with these accommodations and diagnoses? Roughly 15 to 20%. (I should be clear that there are some private schools known to cater to kids who have difficulties in normal public schools -- this was not that kind of school. You'd only tend to go here if you were rich and your parents wanted to get you into an elite college.)

Now, there are a couple potential explanations for this significant difference.

(1) The elite private school with rich kids had parents who had enough resources to devote to diagnosing obscure disorders and borderline cases, where the public school kids had to depend on an overworked school psychologist or something to note some problems.

(2) The more cynical explanation: The rich kids got extra time when they wanted it because the parents had the resources to find a psychologist who could find a vague or "flexible" diagnosis that would allow the kids to have a "leg up" on not only standard school assignments, but also things like standardized tests (extra time on the SAT, etc.). A number of these diagnoses are related to things that would put a kid somewhere on the autism "spectrum."

The second cynical explanation is not just idle speculation. It's been a documented trend, along with overprescription of drugs that have some cognitive benefit, which has received major media attention.

Honestly, I'm sure both of these explanations are true. But they both go a long way to explaining the continued rise in documented cognitive disorders -- and as more middle class parents learn about these things and want their kids tested (either because they legitimately see something wrong, or because they want to try to "game the system" like their richer peers), it's inevitable that the numbers will go up.

In recent years, I've been teaching at the college level, and I've seen similar trends. Kids at elite institutions are more likely to come in with lists of accommodations for extra time, etc. because of some obscure cognitive disorder, while kids at lesser universities usually only have these things when they are truly struggling.

I have a friend who is an educational psychologist, and when I asked her about my observations, she flat-out told me that many of the diagnoses I've seen for rich kids are used precisely to take advantage of the system, because they are more vague in terms of diagnostic criteria.

I should be clear that I also have some people in my family who have severe cognitive disorders, and I completely understand why parents fight at every level to get whatever help they can for their kids. But it's also clear that there are people taking advantage of this system, which is driving up diagnosis numbers, but also drawing resources away from kids who really need it. It's also created this bizarre system in education where your diagnosis determines whether you get "double time" or "time-and-a-half" or "time-and-a-quarter" or whatever for tests, including major standardized ones that can have significant impacts. How do we diagnose kids with that level of precision to determine exactly what "handicap" to give them, and how do we deal with rich parents who can "shop around" for a convenient diagnosis from a psychologist?

Re:Or endless 'vaccinations'

[DarwinSurvivor]

Please stop spreading the vaccine-autism bullshit. It's been consistently debunked and was only ever supported by a single flawed study that a celebrity took charge of spreading to scare parents out of vaccinating their children.

Putting the cart before the horse

[Buck Feta]

The question is simply answered: diagnoses are more prevalent because the drugs to treat those patients now exists. It is not mere coincidence that the FDA approved the use of Risperdal in late 2006, and its generic, Risperidone, in late 2008. There were more than a few doctors who have made more than a few dollars from prescribing tis medication. Johnson & Johnson has to pay a $2.2 billion dollar fine for illegally marketing this drug through the use of kickbacks to doctors and pharmacists. So don't tell me the pharmaceutical isn't dirtier than a whore's whose-its. Everyone relax. Autism rates will decline when these drugs get a bad enough name. Then, a more expensive drug will be produced to treat a more common malady, and everyone will freak the fuck out again.

Re: Clearly vaccination is to blame!

[Travis Mansbridge]

One thing that is certain is that vaccines save the lives of hundreds of thousands of children every year. But by all means, forego them if you really don't want to "take the risk."

School aid

[Charliemopps]

So the neighbor kid was diagnosed with this... and I didn't want to irritate his parents by pointing out the obvious but that kids just obnoxious, there's nothing wrong with him. But oh well... then the school brought in a specialist for MY kid, and they determined that my kid was having trouble in school because he was bi-lingual. You see, my son was born in Africa and we adopted him when he was 2. The funny thing is, he never spoke their language. The only word he knew in his native language when we got him was "Abas" which means "Father" which he'd yell whenever he was afraid of something. I pointed this out to the school but they insisted. Being somewhat of a libertarian I objected to the school wasting money on a special program for him. Then they got nasty. I was trying to impede the progress of my child and it would not be tolerated. A week later the teacher had an assistant 2 days of the week provided by the state to handle her "Bi-lingual" class. Ah, it was all clear now... The school diagnoses disabilities to garner more aid, and more resources from state and federal agencies. They push parents to doctors they know will produce favorable diagnoses and use anything they can find in the childs background to get the result they want.

Re: Clearly vaccination is to blame!

[Bengie]

Doctors will NEVER admit they're wrong.

And you're right, they don't know what causes it, why are they so quick to say the vaccines aren't connected?

"Are so quick"? Several different Universities have done research on the subject over many years and all came to the same conclusion, Autism rates are the same in people who get vaccines as people who don't.

Re: Clearly vaccination is to blame!

[naasking]

And you're right, they don't know what causes it, why are they so quick to say the vaccines aren't connected?

Is this a serious question? There was one study which suggested a link (Wakefield). This study's data was fabricated, and was later retracted Wakefield's license was revoked. There were then a flurry of studies showing no link between vaccines and autism. You really think that's "quick to say"?

Conflating

[Sockatume]

Beware of conflating autism with autism spectrum disorders and asperger's syndrome. Classical, pre-2000s autism isn't a faddish behavioural disorder, it's the kind of debilitating condition that can require life-long professional care.

Autism is too broad and other problems

[erroneus]

First of all, just going to say it again. The definition or classification "autism" is too broad. Different people under the classification have different ranges of impairment. It needs to be broken down. In one area, Asperger's, it once was and has since been blocked in with Autism Spectrum Disorder. Why? (perhaps part of the larger trend of tyring to label more people as "mentally incompetent" as a means of separating people from their rights?) I don't know.

But instead of creating a broad classification and diagnosis, there needs to be increased study into variants and ranges of disability. Some people are just fine and are a bit awkward while others are completely incapable of taking care of themselves. It's inaccurate to simply put it all under that one umbrella and treat things under a "common core" and ultimately unhealthy to do so.

But the complete and utter resistance to seeking out causes blows me away. If one in 68 children were missing limbs at birth, there would be an international outcry. But because the impairment isn't readily visible, people want to ignore it and especially many want to deny it even exists at all seeking to classify it as a "choice" or "behavior disorder." Those people seem to be incredibly selective of their understandings of the connections between the body and the mind. On one hand we all agree and understand that hormone and other chemical balances of the body and especially nutrition and the use of drugs have a profound effect on the mind. Yet at the same time, there is a set of people who want to believe something entirely different despite knowing what they surely already know. (We're magical spirit creatures inhabiting bodies... ignore the fact that taking chemicals can change how your spirit creature feels and acts. People seem immeasurably incapable of connecting the body and the mind.)

Why aren't we investigating more? Why?!

This problem definitely fits the definition of "epidemic" and yet somehow it doesn't warrant investigation and study? Is it because important business models will be threatened? I believe that will be of high likelihood. Some might think it's worse than that and I hope that's not it but there are documented and unclassified cases where out very own US government really and truly has done things to people -- horrible and terrible things. Sometimes it was intentionally and other times perhaps out of wilful ignorance. The question of intent is important, but we do have some basic facts we can at least point to:

1. The rate is high and climbing still.
2. The problem isn't being studied properly.

That's enough for now. It needs to be proven or disproven. There's no need to go any deeper than that at this point.

Bring on the armchair scientists

[TeethWhitener]

Here's an exercise: count up how many of the posts above begin with "I'm not a mental health professional, but..." or "I don't have any scientific data to back this up, but..." followed by some theory about how autism is overdiagnosed/not real/etc. It's amazing how people will lambaste (rightfully) a woman--famous for showing her vagina and advertising electronic cigarettes--for claiming without evidence that vaccines cause autism, and yet turn around and promulgate some other ridiculous claim about autism, all while ignoring 1) the clinical evidence that exists, and 2) the interpretation of that evidence by those most qualified to interpret it. Pot, meet kettle.

Re: Clearly vaccination is to blame!

[BlazingATrail]

Herd immunity starts to fail and those idiots that don't immunize start to affect those that can't be immunized such as pregnant women and babies. imo, you refuse to immunize you should be placed on No fly list, refused entry into school, government buildings etc. Treated like a leper, yes.. but you had the choice of a freely available cure.

Autism and hypothyroid

[RebelWithoutAClue]

I'm surprised that no one has mentioned this study yet. Perhaps Hypothyroid rates are skyrocketing and with it autism? http://www.sciencedaily.com/re... Autism four times likelier when mother's thyroid is weakened Pregnant women who don't make nearly enough thyroid hormone are nearly 4 times likelier to produce autistic children than healthy women, report scientists from the Houston Methodist Neurological Institute and Erasmus Medical Centre in an upcoming Annals of Neurology. The association emerged from a study of more than 4,000 Dutch mothers and their children, and it supports a growing view that autism spectrum disorders can be caused by a lack of maternal thyroid hormone, which past studies have shown is crucial to the migration of fetal brain cells during embryo development.