Contributors to the rise in autism?

[Gramiscus]

The rate of diagnosed Autism Spectrum Disorders has been increasing exponentially since the 1970's. Numbers rose from circa 1 in 5000 children <diagnosis by age 8> to about 1 in 88 in 2012, as estimated by a CDC study.
I don't have over 15 posts yet, so just google the number if you want to read about the CDC's study.

The increase is getting faster and worse every year. But how much of this rise is real (meaning actual increase of ASD related pathology and not diagnostic issues), and what does the real rise mean?

ASD is a psychiatric diagnosis based on behavioral cues. Researchers believe that there may be many types of underlying neuropathology that culminate at the common tell-tale signs of ASD. So, ASD is a very broad diagnosis. The rise is likely due to a variety of factors.

The USA alone spends over $130,000,000,000/yr on ASD treatment... estimates believe that this is roughly 3.2 million USD over the lifetime of an autistic person. By 2020, even if the increase does not go up further, the US will spend over a trillion USD on ASD treatment at the current rate. It will likely continue to increase, and this number will go up.

What kind of things do you think are contributors to the rise in ASD? I heavily suggest doing a pubmed/google scholar search on your argument topic. It's a trend that heavily concerns me for the mental health of future generations, and the economic stability of the world.

 

[sophia8]

The rate of diagnosed Autism Spectrum Disorders has been increasing exponentially since the 1970's. Numbers rose from circa 1 in 5000 children <diagnosis by age 8> to about 1 in 88 in 2012, as estimated by a CDC study.
I don't have over 15 posts yet, so just google the number if you want to read about the CDC's study.

This study? Which is dissected here:

The bottom line is that in the cohort born in 2000 approximately one in 54 boys and one in 252 girls living in the ADDM Network communities were identified as having an autism or ASD diagnosis. One thing that we should be clear on right here because it’s right in the report is that ADDM Network sites do not make up a nationally representative sample, which means that these prevalence numbers can’t be generalized to the whole U.S.

(my bolding)

The increase is getting faster and worse every year. But how much of this rise is real (meaning actual increase of ASD related pathology and not diagnostic issues), and what does the real rise mean?

Almost certainly, most of the rise can be explained by changes in diagnosis:

Last year, a fascinating study by Brugha and colleagues attacked the same question from a different angle. They did an epidemiological survey of a representative sample of adults from the English population, using the ADOS-G, and found that the rates of ASD were similar to those recently reported in children. Within the adult population, rates of ASD did not change with age. Thus, provided we stick to the same diagnostic criteria, then the prevalence of autism is the same for those born several decades ago, as it is for the current generation of children. Importantly, none of these adults with ASD had received a formal diagnosis.

The USA alone spends over $130,000,000,000/yr on ASD treatment... estimates believe that this is roughly 3.2 million USD over the lifetime of an autistic person. By 2020, even if the increase does not go up further, the US will spend over a trillion USD on ASD treatment at the current rate.

Cite, please. And you must surely be aware that the autism diagnosis includes HF (high functioning) autistics; i.e those with Asperger's syndrome. They most certainly do not need money spent on their "care".

 

[jdc324]

Re the changes in diagnosis mentioned by Sophia8:

There's an interesting paper from Shattuck: http://www.ncbi.nlm.nih.gov/pubmed/16585296

The average administrative prevalence of autism among children increased from 0.6 to 3.1 per 1000 from 1994 to 2003. By 2003, only 17 states had a special education prevalence of autism that was within the range of recent epidemiological estimates. During the same period, the prevalence of mental retardation and learning disabilities declined by 2.8 and 8.3 per 1000, respectively. Higher autism prevalence was significantly associated with corresponding declines in the prevalence of mental retardation and learning disabilities.

Baird: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC188387/

The number of children diagnosed as having autistic spectrum disorders is increasing.12 Studies investigating this phenomenon have concluded that several factors account for the increase—for example, changing conceptualisation to a spectrum rather than a core categorical condition; changes in diagnostic methods; and the inclusion of children with disorders such as attention deficit hyperactivity disorder, Tourette's syndrome, or tuberous sclerosis as also having autistic spectrum disorder.

 

[Beerina]

The USA alone spends over $130,000,000,000/yr on ASD treatment...

That's a lot of freakin' BMWs.

 

[Staffsknot]

It has already been said, but I would put it down to the changes in diagnosis methods that have been made over the years.

 

[Perpetual Student]

How about over-diagnosis?

LINK

 

[Elaedith]

If the proposed revisions to the DSM go ahead Asperger's syndrome will no longer be recognised as a distinct disorder. It will be interesting to see how a single diagnostic category affects rates of diagnosis.

Field tests suggest the new criteria are more stringent and would exclude some currently diagnosed.

Example
http://www.jaacap.com/article/S0890-8567(12)00042-1/abstract

 

[jasonpatterson]

I was listening to The Diane Rehm show a month or three ago (on World Autism Day, perhaps, can't recall) and I remember one clinician who was saying that parents often sought an autism diagnosis. According to the doc, schools typically have much better services for kids with autism than for less fashionable mental disabilities, and that was what the parents were after.

Clearly my memory of what some person said on a radio show without any supporting evidence is not a solid argument, but it's definitely plausible.

 

[Gramiscus]

Not completely diagnostic changes, according to experts

Thank you for everyone's feedback. I will need some time to prepare appropriate replies for some of the comments that were made here. I hope to get back to them (and future comments) over the next few days. Please keep the flow of ideas and skepticism open.

re: costs of ASD for USA

Cite, please. And you must surely be aware that the autism diagnosis includes HF (high functioning) autistics; i.e those with Asperger's syndrome. They most certainly do not need money spent on their "care".

Hello, I cannot post links directly so please fix this address (remove spacings and add extra 'w'.). It is not a scientific publication itself but is relating to one study that was performed. A cursory google of "cost of ASD treatment for USA" will give similarly very high numbers of varying degrees.
ww.healthyfloridians.com /documents/ Ganz.ppt

re: Diagnostic substitution increasing the prevalence of ASD
I would also like to draw people's attention to a large number of studies that were performed claiming that diagnostic substitution can not fully justify the rise in ASD. Many experts are concerned that environmental teratogens are playing a significant role in the increase, and diagnostics problems cannot account for the entire rise.

re: Mental retardation vs Autism (remove spacings to fix address)
http ://photon inthedarkness .com/?p=158
There was some study performed that showed a correlation between the lowering of mental retardation and the raise in autism. Correlation is not causation, and this correlation is not perfect regardless. One will note that the lowering of mental retardation and the rise in autism did not occur hand in hand; there were many years where autism rose and mental retardation did not lower (from 1993-1999). What could be causing the rise during this time period, if not mental retardation diagnostic substitution?

A fellow named RAJ in the posts underneath mentioned:
"The upward trend in prevelance can be traced to the pivotal year of 1994. That year Kanner’s definition ‘A pervasive lack of responsivenss to other people - autism’ which was a requirement for an ‘autism’ diagnosis between 1980 and 1993 was completly removed from all diagnostics schemes and replaced by the vague, ambiguos and subjective ‘Qualitative impairment in social reciprocity’."

Admittedly, at this point, there feasibly was a significant leakage of MR into ASD through diagnostic substitution. However, I am also finding studies that have investigated the amount that diagnostic substitution has played a part between 1992-2005 -- and I have found more than one study is saying this -- only one quarter or so of the rise is due to diagnostic substitution.
(remove spacing for working link)
http ://ije.oxford journals.org/ content/38/5/1224.full

So... There are many articles that say that diagnostic substitution is not likely to be the main culprit, or has not been proven to be yet. I am concerned that people are jaded over autism, and are willing to ignore what may be a true increase beneath the superficial increase caused by societal/medical trends in diagnostics.

I am writing a paper right now on what I believe may be a contributor to the rise. Will be happy to bring that up in the future for questions and opinions on the topic, but I would like to hear what people's questions and skepticisms are beforehand first on the topic as a whole.

Your replies and input are very welcome! Thank you.

 

[Monketi Ghost]

How about over-diagnosis?

LINK

Bam.

We tend to have waves of popular diagnoses as the years roll by.

 

[Gramiscus]

Bam.

We tend to have waves of popular diagnoses as the years roll by.

I admit that there may be a "trend to have waves of popular diagnoses as the years roll by", but correlation is not causation in all cases... and in the case of your arguments, can you show that the change in diagnostic criteria justify all of the rise?

Do you deny the possibility that there could be a concurrent issue besides just diagnostic changes?

 

[Estellea]

You will find this interesting: http://leftbrainrightbrain.co.uk/20...he-1980s-utahucla-autism-epidemiologic-study/

Since consistent and rigorous statistics have not been kept, along with the numerous confounding factors, e.g. changes in the DSM, socio-economic status, educational services, etc., it is difficult to make absolute pronouncements with regards to the increase in ASD prevalance. However, the data we do have are strongly suggestive of diagnostic substitution, awareness and expanding criteria but with the possibility of environmental influences that may or may not effect the actual prevalence, whatever that may be.

Oh and RAJ is a contrarian tool so I wouldn't put much stock into his comments, whereas Prometheus is an excellent academic researcher who knows his way around autism issues.

Este

 

[Monketi Ghost]

I admit that there may be a "trend to have waves of popular diagnoses as the years roll by", but correlation is not causation in all cases... and in the case of your arguments, can you show that the change in diagnostic criteria justify all of the rise?

Do you deny the possibility that there could be a concurrent issue besides just diagnostic changes?

Nope, can't show that the change in diagnostic criteria justify all of the rise, but I wouldn't try to claim it.

I wouldn't deny the possibility that there could be a concurrent issue besides just diagnostic changes.

I await anything, say an environmental factor, that could help explain the rise. But the best explanation is a newly popular diagnosis. Anguished parents are especially vulnerable because they want to hear ANY answer that isn't "We don't know".

 

[Gramiscus]

Could prenatal ultrasound be an ASD-inducing teratogen?

You will find this interesting: http:/ /leftbrainrig htbrain.co.uk/2012/07/03/autism-spectrum-disorder-reclassified-a-second-look-at-the-1980s-utahucla-autism-epidemiologic-st udy/

Since consistent and rigorous statistics have not been kept, along with the numerous confounding factors, e.g. changes in the DSM, socio-economic status, educational services, etc., it is difficult to make absolute pronouncements with regards to the increase in ASD prevalance. However, the data we do have are strongly suggestive of diagnostic substitution, awareness and expanding criteria but with the possibility of environmental influences that may or may not effect the actual prevalence, whatever that may be.

Este

I'm glad that this post was made. It is a frustrating issue, and you are spot on. I came to this topic not directly from autism research, but from ultrasound bioeffects studies - and this problem has been why I wanted to ask JREF to see if anyone else had any ideas regarding this.

I want to approach this topic very carefully, because I personally am very excited about the future of medical sonography. I think that it is a simply awesome modality for a variety of reasons and would not want to see it get demonized. All the same, it was mentioned by you and corroborated by many other experts that some environmental exposure could lead to developmental problems as seen in ASD... Coincidentally, there has been rising concern from ultrasound researchers that prenatal sonography could be implicated in having some deleterious impact on fetal development, possibly like that seen in some cases of ASD.

The correlations of epidemiology and are there. One can see from the history of ultrasound on OB/GYN -- (remove spaces to see site)
ht tp: //ww w.ob- ultrasound.net /history.html
-- that ultrasound came to worldwide use around the same time that autism began to spike up. In 1992, the FDA increased the regulation output for fetal sonography 8 fold to meet commercial needs -- not based on proof of safety.

So, I have a new question for those of you interested in this thread... Do any of you who know autistic people, happen to know if that person received fetal ultrasound exposure during the first trimester? Or perhaps extensively later in development (such as is common for high risk pregnancies)?

If you would like to read about the ultrasound-autism connection a little bit, I published a paper in a low visibility journal to get feedback and honest criticism before coming out in the open with this topic. (remove spaces)
h ttp:// uncw .e du/csurf/Explorati ons /documents/blakedavid. pdf

Your opinions and criticism are definitely appreciated-

 

[Estellea]

Gramiscus, I gave your paper a cursory read and have some critique. You conflate 'incidence' and 'prevalence' throughout the paper. You may think this is immaterial but it isn't and proper nomenclature is appreciated. You seem to have cherry-picked some of your citations. For instance, Deth is not well-respected in terms of his autism balliwick, mercury. The mercury-autism hypothesis has been long disproven but Deth has made a zombie of it and appears at dubious 'autism conferences' to pimp it. You also don't include the British survey of adult autists which puts a severe dent in your hypothesis. You also don't include anything by Shattuck nor anything about changes in the DSM and how they contribute to ASD ascertainment. You seem to be extrapolating local data, e.g. California department of education to global populations so you need to be mindful of external validity.

You make a comment about 'significant number of trends' but fail to qualify this with any statistics. The term 'significant' in a scientific publication is nearly tacit for statistical significance and should be qualified thusly. There is a big problem with your figure 2 and that is you used the number of published U/S studies to quantify your trend but not actual usage?! You also don't use the same scales for your axes and why did you cut out at 1987 and 1978? This does not support your hypothesis at all and makes it appear as though you either don't know what you are doing and/or are being disingenous. It is a trick used by slimy anti-vaxx 'researchers'. I'm not accusing you of anything nefarious but cautioning against your appearance as such.

I don't think that your extrapolation of in vitro and in vivo experiments and observations are as supportive as you think they may be due to the widely varying exposures in both type, time and scope of U/S exposures which were often much higher than anything a human foetus would be exposed to. You report no statistical significance in figure 3 but report a 'signficant' drop in the MUS group growth rate without any quantification such as confidence intervals and p-values. I'm not going to go through your references to compare with your statements but I think it's safe to say that you over-stated the correlation. That said, I think you have some interesting ideas and if you don't get too wedded to your hypothesis (i.e start believing something is there when it isn't), stay true to the scientific method to disprove your hypothesis, then you might be on to something. My suggestions would be to start looking at neurological findings in autistic brains, designing experiments that have more external validity to test your hypothesis and please consult with a statistician and/or epidemiologist if you are going to conduct any more studies requiring statistics and epidemiology.

Este

 

[truethat]

I was listening to The Diane Rehm show a month or three ago (on World Autism Day, perhaps, can't recall) and I remember one clinician who was saying that parents often sought an autism diagnosis. According to the doc, schools typically have much better services for kids with autism than for less fashionable mental disabilities, and that was what the parents were after.

Clearly my memory of what some person said on a radio show without any supporting evidence is not a solid argument, but it's definitely plausible.

Here in NYC nearly ever single Jewish woman I work (I teach Special Education teachers) with has a child diagnosed for special education. Autism, since it has a spectrum that goes up to Aspergers is a common diagnosis for the state to pay for expensive private schools in Yeshivas. I'm not saying it's partial to the Jewish community but since so many of these schools are set up in Yeshiva systems and parents want their kids to get free tuition they definitely get diagnosed when they are not autistic.

I spoke in another thread about this and pointed out a friend basically told me her son was Autistic but he was not, seriously maybe he "got better" as she likes to say but it payed for $20,000 a year tuition for private Yeshiva.

 

[ThunderChunky]

I am writing a paper right now on what I believe may be a contributor to the rise. Will be happy to bring that up in the future for questions and opinions on the topic, but I would like to hear what people's questions and skepticisms are beforehand first on the topic as a whole.

Autism is genetic, this is known. Usually de novo mutations (mutations that arise in the germline of the parents or early development of the embryo) which is why they have been so hard to identify, but that have been recent advances.

Here's a cutting edge paper by well known scientists in the field where specific mutations are identified. http://www.ncbi.nlm.nih.gov/pubmed/22495309

Since we know the cause of autism is genetics, there either has to be something in the environment that is causing more mutations in people (yet that would lead to an increase in a whole lot of diseases) or the rise is due to a change in diagnosis (but not prevalence).

 

[Deetee]

The USA alone spends over $130,000,000,000/yr on ASD treatment... estimates believe that this is roughly 3.2 million USD over the lifetime of an autistic person. By 2020, even if the increase does not go up further, the US will spend over a trillion USD on ASD treatment at the current rate. It will likely continue to increase, and this number will go up.

Myth.

I think the stats are that the average costs associated with lifetime care for a severe autistic child will be $3 million.

Naughty people have then used this figure to overextrapolate, saying that every one of the 1 in 88 kids diagnosed on the autistic spectrum will need $3 mill per year. Not so, obviously, since the majority of them are higher functioning and probably will cost little, if anything at all.

 

[Mark6]

I was diagnosed with Asperger Syndrom years ago. Where do I get my $3.2 million?

 

[Gramiscus]

Awesome replies

The responses so far have been simply awesome. I want to thank everyone for their ideas and suggested criticisms. This all has been a learning experience, but I am genuinely interested and very invested in learning more about this subject.

It is not my intention in any way to promote hearsay, and I want to make sure that when I publish this report in a more visible journal that it is set with a well crafted foundation that is able to reach intelligence skeptics with reason, and good science. One of the difficulties I am facing is with the obstacles of scientific literature; there is a different kind of flow with face to face communication. I am still learning, so please bear with my inexperience with technical writing.

There are many things that I have learned since my last publication, and I have met with a variety of neuroscientists to discuss my thoughts with. Give me some time to digest what has been said and to reply with some of the things that I have learned.

I will respond to the criticisms and replies asap and hope to foster further skepticism and thought.