Increase in Autism Diagnosis

[Emergent, RN]

The latest vaccination thread got me curious about autism and its higher rates of diagnosis today compared to past years. The link below discusses this. One theory is that autism is not actually increasing, but diagnosis of it is. That theory basically negates any links to environmental causes, such as vaccines, for instance.

The Increase in Autism Diagnoses: Two Hypotheses « Science-Based Medicine

This second link is to a academic study that is harder to read.

Social Demographic Change and Autism

I'll admit, I haven't thoroughly read it, only scanned it for interesting tidbits. It discussed social demographics of those with the autism.

This paragraph popped out at me, which essentially says that a diagnosis of autism is more socially acceptable than one of mental retardation (terminology from article, not me) See quote below, I bolded the idea I wanted to bring up.

In broad sweep, three ideas motivate most of the current accounts of the increased prevalence of autism. The first account is that increased prevalence stems from diagnostic dynamics, driven by process of diagnostic change, substitution, and drift (Shattuck 2006). Support for this hypothesis arises from the fact that early on in the epidemic, one could not observe the classic socioeconomic status–health gradient and that autism spectrum disorders (ASD) appeared to be a diagnosis of choice for middle- and upper-class parents whose children would be otherwise diagnosed as mildly or severely retarded, a disorder still associated with increased stigma. King and Bearman (2009) estimated that roughly 25% of the increased prevalence of autism is associated with diagnostic change on the mental retardation (MR) pathway.

I've wondered about this. I'm just a dispassionate observer in this topic, I follow the news and lean toward the theory that Autism is diagnosed more today, probably for more than one reason. I never bought the theory of it being caused by things like vaccines. I've seen too many trends of increased in diagnosis of other diseases such as ADHD, Bipolar, Fibromyalgia, all conditions that were previously not recognized.

I'd love to hear from folks, especially those with family members or friends with this condition. The second article also mentions that the diagnosis is more common in children born to older mothers. Of course, older mothers tend to have a higher socioeconomic status, but have higher rates of genetic mutations as well. I want to read the study thoroughly, but have to get ready for work. Very interested in feedback here.

[ixchel]

My "belief" on the subject is that diagnostic criteria has changed, recognition of autism happens more by families than it used to because society as a whole is more educated about it, it isn't hidden by families who are ashamed of it, and so on.

By the way, there has literally never been a study that has revealed a connection between autism and vaccination. Thanks to that British idiot and the journal that actually published him, a massive amount of research has tried very hard to link autism to vaccination and it just hasn't happened.

[toomuchbaloney]

I believe that we will discover that it is related to either an environmental or ingested exposure to an "agent" which affects that neuro development in the 3rd trimester. It seems that current research in proteins is promising and some interesting observations have been noted. I won't be surprised if they link some prenatal exposure to alterations in gene expression (and protein creation) which result in the wide spectrum of disability that we see with ASD.

[Emergent, RN]

P.S. I hope this thread doesn't turn into a pro/anti vaccination mud-slinging , name-calling fest. Thank you toomuchbaloney for your interesting input. I think calling people idiots is counter-productive. Let's hear some more theories, or about the latest research!

[KatieMI, BSN, MSN, RN]

Ok, just from personal experience:

I gave birth to hardly 30 weeks, 1 pound 2 oz premee about 12 years ago. While she was in NICU (in a huge, very much academically-associated center), we were told that her development will be "DELAYED", and they used the same word during follow ups. After 3.5 months, we came to much smaller regional medical center under care of an ordinary pediatrician for everyday problems. This doctor took a look at my baby and, in sympathetic voice, said that her development will be "delayed" for sure but also that she is going to be "RETARDED". She put it as two different things, in terms of long term prognosis - former one as a problem of pace, and latter one as problem of final outcome. Fast forward, my little girl reached 18 months meeting milestones as appropriate for preemies but not speaking at all at that time. Mind it, our family is tri-lingual and that was one reason I was not too much worried. But, eventually, we were sent to another academical center for eval. The first thing the doc told me, before even seeing my girl, was that she had AUTISM beyond any doubt, because 1) she is not speaking at that age, 2) she must meet a, b, c and so forth milestones at this and that age however complicated her health history might be, and, most importantly, 3) we had one of the best private insurances in the whole country, "which will pay for all services so you may not worry".

All three "services" had been seeing the same child, within weeks of each other. All three had access to the whole medical history and dealt with knowledgeable, compliant parents.

IMHO, the latter "diagnosis" was directly linked to our family social status and previous history of compliance as well as insurance being known for paying for whatever without many questions asked. After we refused to accept their "services", they tried to contact CPS, which speaks volumes for me about their motives.

I really think that social acceptance of "autism" as diagnosis and readiness of insurances to pay for treatments could play more than minor role in increased "incidence" of autism. How much more convenient and, that is to say, appropriate it is to have an autistic kid than to have a child with, say, alcohol-related fetal syndrome!

P.S. Not so long ago, I was again asked if my girl should be evaluated for ASD...by another mom who found the fact that the pre-teen might be Steven Hawking' adorer and take high school statistics class for fun "strange" and "geeky".

[Libby1987]

This is an ignorant observation but the kids I've seen who were diagnosed autistic seem to have an entirely different type of cognitive presentation (is that the right word?) then the adults I've known with the classic mental retardation/slowness. They don't seem equivalent. Does that make sense?

[mariebailey, MSN, RN]

How odd that autism is going up after manufacturers took preservatives out of the vast majority of all vaccines received in childhood? I'm being sarcastic. Childhood vaccines, for the most part, are now in single dose vials & contain no preservatives implicated in autism. WE NEED TO START LOOKING FOR THE REAL CAUSE OF AUTISM. YES, I'M SHOUTING.

[mmc51264, BSN, MSN, RN]

My child is on the autism spectrum with an IQ >160. He just looks at the world differently. The general, sweeping term "autism" is such a sweeping generalization that is really is useless.

[elkpark]

I'm in child psych and I have personally been present at rather sketchy public presentations aimed at parents (the general public, that is) at which "professionals" advocated pushing to get your child dx'd with an autism spectrum disorder because that will open up a whole world of services for your kid at the school that you otherwise would not be able to access. It was being presented as a sort of clever way to game the system to get your kid extra assistance and attention.

I always wonder, in conversations about the rise in ASD dxs, how much that may be a factor.

I can also vouch, from my own clinical experience, for the idea that autism has somehow become a more desirable dx than mental retardation, and parents really push for that. I don't really get how it is less stigmatizing, but, apparently, it somehow is.

[mmc51264, BSN, MSN, RN]

but aren't there very different criteria for what is considered mentally retarded and autistic? Mentally retarded infers a cognitive isse where autism is not (I can't think of an appropriate term!). Most autistic children, in my experience (I was a school teacher before I was a nurse), don't necessarily have a cognitive delay or impairment, they seem to have other function deficits-for example, my child is a textbook example of "executive dysfunction" he is brilliant but would lose his behind if it wasn't attached. he has lost three winter coats this year alone. We are working on teaching him strategies to organize. Many of his teachers think that he is just lazy. he is not.

It is a fascinating topic to me and sad that there are many so-called experts that abuse their credentials

[klone, MSN, RN]

My daughter (14) has Asberger's, diagnosed about 8 years ago. At age 3, they conducted some type of IQ testing on her, and she was thought to have mental retardation based on the test, which I knew was not accurate because the reason she did so poorly was her inability to communicate with the testers, not lack of cognitive function. She has had cognitive delays as well, but the majority of her issues stem from a more difficult time reading and understanding social situations and mores. At 14 and in 8th grade (we chose to repeat a grade when we moved from one state to another), she's doing quite well academically, and has a very small circle of close friends who are equally socially awkward.

Most people, when meeting her and knowing her on a superficial level, do not know that anything is "wrong" or different, other than she is perhaps a bit quirky and immature for her age.

[imintrouble, BSN, RN]

Is it possible that we, as a society, are less accepting of differences in behavior over all? Is there more of a need to categorize everybody? Do we need to label and pigeon hole people?

I don't know.

I think I'd like to read a study on that.