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    CDC: Autism Jumped 30 Percent Since 2012 - What It Really Means
    By Hank Campbell | March 27th 2014 10:14 PM | 8 comments | Print | E-mail | Track Comments
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    America has seen a 30 percent rise in autism since the last estimate in 2012, according to the Centers for Disease Control.

    That's a big jump, an epidemic even. Mainstream media is going to have a field day and everyone will be looking for ways to demonize their favorite societal targets.

    Before we start writing to Congress, we need to keep a few things in mind.

    (1) It's an estimate based on diagnoses

    The first thing we need to realize is what the numbers mean. The CDC doesn't know how many cases of autism there are, they just estimate based on how many autism diagnoses there are. And that is not always telling us a meaningful story. An interesting study found that if you go to one area of Los Angeles, for example, you will find a true nexus of autism. Autism diagnoses up to 6X higher than elsewhere in California. Does Hollywood cause autism? No, wealthy people tend to get diagnosed with a lot more stuff and we can see it in that study, where kids who did not have autism moved there and suddenly became diagnosed as autistic. It is not an autism cluster, it is a diagnosis cluster, created by a whole lot of pediatricians who are meeting demand.

    Maybe that is why 1 in 45 kids in New Jersey are diagnosed with autism while only 1 in 175 children in Alabama are. 


    Estimated prevalence of autism spectrum disorder among children aged 8 years, per 1,000 — Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2010. Source: Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010 March 28, 2014

    But, might that disparity be that kids in Alabama are under-diagnosed? Sure. If you want to engage in cultural elitism you can also claim that autism just doesn't stand out in Alabama.  The CDC even gets in the obligatory shout-out to Obamacare, noting for residents of Alabama that there is now no longer a reason their children can't be diagnosed with autism the same way wealthier New Jersey kids are.

    The results highlight a problem with modern epidemiology - it can mean anything people want it to mean. And it often does.  

    Since epidemiologists find matching data and imply causation, they can blame pesticides for increased autism. They can also blame organic food. We can find curves for both that match the increase in autism diagnoses - and that is the problem with statistics from the CDC if they are not properly calibrated.


    If you just want to find two curves going the same way and imply causation, you can. That does not make it valid. Link: io9

    It can also apply to any disorder that is symptom-based and subjective. It can apply to any country. It may not be that developing nations have less autism, they may not have been told they have it yet. The Implicit Association Test was not created to figure out if you are racist, but to prove you are racist even if you are not. The criteria for putting a child 'on the spectrum' is just as deterministic. If a mother says a child has behavioral issues enough, some doctor or psychologist is going to agree. And as we see in the details, a whole lot of these diagnoses are subjective behavioral claims rather than diagnostic.

    So estimates based on diagnoses are not telling the complete story because

    (2) It's not a nationally representative sample

    The CDC funds grantees for this. It is not nationally representative, it is based on the state's ability to report on autism statistics. And they use DSM-IV for criteria, which is an important piece of data. The National Institute of Mental Health has said it will not use DSM-5 as anything more than a glossary, because DSM remains too much of a hodge-podge of symptom-based diagnoses and special interests all competing to get covered under insurance. There's little science, at least not how we understand science in the last 50 years, and a whole bunch of people who were on the autism spectrum in DSM-IV might not be under DSM-5. Once DSM is not a reference for the NIMH, it won't be paid by insurance so easily. Unfortunately, a lot of people who really need services are going to be caught up in that but they are being impacted now, because the competition for those services is being amplified by aggressive diagnoses. 

    The latest estimate is based on 2010 results. It included 363,749 children aged 8 years in 11 states. The prevalence was 14.7 per 1,000, which translates to 1 in 68. But the way those numbers are drawn remain inconsistent, at least if we want to create an action plan. Arizona's numbers on autism, for example, were 58% exclusively from education sources while that was only 14% in Utah.

    It's not wrong, it is just that out of context, and showing up in a broad claim, like 1 in 68, it isn't helping people understand what is happening or even if anything has changed. In states that reported intellectual ability, less than 10% of kids with autism were receiving special education services under a primary eligibility category of intellectual disability. That means there were instead behavioral issues, which might range from severe to just personality variance.

    The CDC lists 5 issues that might confound their estimates, but you aren't likely to see them in most coverage: Not representative; inconsistency in population denominators and 33% of the sites didn't report education statistics. The other two were relatively minor - racial definition across regions and lack of intellectual disability statistics in all sites.

    And they acknowledge that the switch DSM-5 could cause the results to fluctuate a lot. Preliminary results show that autism diagnoses today would mean 31% of cases could disappear. When people are lobbying to have their kids be autistic, it makes for difficulty in providing real data. So, autism diagnoses could drop a lot in 4 years, even though nothing much may have changed.

    Obviously, autism is better diagnosed but it is also sometimes over-diagnosed. Middle class white boys get an overwhelming number of these diagnoses and, overall, boys get 5X the diagnoses of girls. Are we to believe this problem is primarily in wealthy white boys? 

    Comments

    Bonny Bonobo alias Brat
    America has seen a 30 percent rise in autism since the last estimate in 2012,according to the Centers for Disease Control.
    The latest estimate is based on 2010 results. It included 363,749 children aged 8 years in 11 states. The prevalence was 14.7 per 1,000, which translates to 1 in 68. But the way those numbers are drawn remain inconsistent, at least if we want to create an action plan. Arizona's numbers on autism, for example, were 58% exclusively from education sources while that was only 14% in Utah. It's not wrong, it is just that out of context, and showing up in a broad claim, like 1 in 68, it isn't helping people understand what is happening or even if anything has changed.
    You make some very good points Hank but if there is a genuinely significant increase in the numbers of children that are suffering from autism then how could scientists objectively and credibly measure and report this?
    My article about researchers identifying a potential blue green algae cause & L-Serine treatment for Lou Gehrig's ALS, MND, Parkinsons & Alzheimers is at http://www.science20.com/forums/medicine
    I feel part of the problem with the diagnosis of autism is that there still isn't a solid definition of autism that most people can understand. The script starts with low socialibilty at age 2 and a continuation of dissociation from then on. That's actually a very subjective description considering that parallel play is pretty normal for the toddler years and any interaction between them (toddlers) is the exception, not the rule. It also doesn't take into account that personality is something that is usually innate and not under the control of the parents so an extroverted adult expecting a mini-me screaming and running around the house may actually be disturbed by a quiet toddler that doesn't take interest in strangers or new toys. There's an obsession with "making" a kid normal and every adult sees themselves as the red-blooded all-American standard of normal so they must already know what is normal for each kid. So if a kid isn't learning how to read fast enough or is running around the house too much then surely this kid isn't normal and is in dire need of medical intervention. If you ever watched the dog whisperer you'd see that we put more effort into making life more intuitive and natural for dog than we do for children. We expect children to compete and socialize in the way we compete and socialize but it doesn't necessarily work like that. The system hasn't always been there and it's argueable if it was ever optimal for more than a minority of children. Winston Churchill was one of the most widely read and stratigically capable leaders in his time but was catagorically a failure in every subject but English all through his school years. He didn't really start learning until he was an adult who became obsessed with reading and educating himself. If you listen to some of the better adapted adults with aspergers theyd say they didn't really start learning until they were in their twenties. My thoughts are They were out of the system and there wasn't any arbitrary conception of normal learning once they were adults because (sadly) "normal" adults don't spend their time learning anything new.

    My two cents says that autism is a sensory distortion like deafness is a sensory loss. Everything takes on too much importance so it's hard to focus on what most other people consider normal. Putting the kids in large social groups at a young age might actually make things worse because they can't filter information to begin with and produce anxiety problems. (I'm certain the gastric problems in autistic kids are due entirely to anxiety shunting blood from the intestines to the muscles causing necrosis in the long term) Anybody whose had an anxiety attack can tell you you're not going to be learning anything new during an anxiety attack other than you really want to avoid this situation. So forcing toddlers into play dates to improve their social skills accomplishes nothing besides social anxiety at a young age. That's my thoughts. Autism needs to be defined more succinctly.

    Hank
    I feel part of the problem with the diagnosis of autism is that there still isn't a solid definition of autism that most people can understand.
    Sure, that is why the National Institute of Mental Health has stopped using it. They took a bad book that was stuck in symptom-based diagnosis from 1960 and let a lot of competing special interests make it worse. The definition is fluid because practitioners want it to be broad enough to cover everyone who wants to be covered
    Finally the voice of reason. You know if baffles me that of everything I read in today's news, I only found ONE article that challenges the figure - http://www.pressreader.com/bookmark/HBRCHVPQ78V/TextView. Taste for drama is one thing, but when it starts to play with the variable of worried parents for example, I think it becomes time to stop and look at the facts.

    Our rise in Autism is explained using easy-to-understand Physics at www.WhyAutismHappens.com

    Phones were too large to carry in your pocket in the mid 1990s (that would be like carrying your TV remote in your pocket) - most people used hip holsters. People didn't start carrying phones in their pockets until the early 2000s (the era of the Motorola Razr). The trend has again moved back to hip holsters with the advent of smart phones. If this was really causing autism, you'd see the trend spike from about 2002-2009, then a sharp decline since then.

    TomBillings
    "No, wealthy people tend to get diagnosed with a lot more stuff and we can see it in that study, where kids who did not have autism moved there and suddenly became diagnosed as autistic. It is not an autism cluster, it is a diagnosis cluster, created by a whole lot of pediatricians who are meeting demand. Maybe that is why 1 in 45 kids in New Jersey are diagnosed with autism while only 1 in 175 children in Alabama are. "

    Maybe so. Diagnosis is one variable. What is lacking in the article is inclusion of other factors, such as births, and why more of us with ASDs might be born in a highly urban industrialialized State, rather than in what was until recently a primarily agrarian State. In particular, the complex explanations for more births do not fit nearly as well as a simple, but unpalatable, one. The genetic correlates of ASDs mostly tend to be SNPs, single folds, and other mutations you would expect to see happening all along, since they happen at all. So why didn't we see ASD reports before at these rates? Why weren't they there? ....Maybe they were, for a short while each.

    Note we *did* get things similar to regressive autism happening, and the evidence is in the "changeling" myths of Europe and elsewhere. These persisted long enough that as late as 1885 a woman in Northern Sweden was convicted of murdering her child by following the old prescription for undoing the "exchange" the "fairies" had caused, to get her child back. She put what she insisted was a "changeling" in a hot oven, expecting that child to disappear, and her own to reappear in his crib. My point is that this behavior is only the most extreme we could expect throughout the "Little Ice Age", when agrarian villages lived on thin margins, requiring hot intense social cooperation to hold starvation at bay.

    Even Aspies, with a genetic set having the fewest differences from the norm, and the least social behavioral lacks, had few places in that agrarian culture. Usually those places would have been limited to "rich eccentric", a reclusive monk or nun, or a graveyard. Note that all of these options have a *very* low reproductive rate! Even there, if the eccentric were "eccentric enough" they could easily become the target of a "witch hunter" and, ...welllll, ..the witch hunter shared the spoils of the witch's estate with the local laird, who was very often the local judge. Given these circumstances before the industrial revolution, it becomes apparent how the percentage of people with Aspergers who got to reproductive age was low. They were too often killed first, if they ever got a chance at all.

    Then came the industrial revolution. As world-wide networks of industrial society needed people badly enough, who could concentrate their attentions on arcane matters, that not being "socially nimble" was tolerated. Aspies began surviving to reproductive age more often, simply because neurotypicals stopped killing us so fast!

    Eventually, the numbers of people with genes for ASDs grew sufficient that they started meeting, marrying, and combining their different gene sets. Each may have been an Aspie before, or may not even have expressed it as a behavior. Often a woman could be "passing". Their child, with both sets of genes, would end up as what we now call autistic, and farther down the spectrum than just Aspergers.

    This pattern is a very possible contributor to the difference between New Jersey and Alabama. New Jersey has been industrializing since at least 1815. Alabama remained predominately agrarian into the 1960s. Lest you think this is made of whole cloth, look at just what sorts of genetic differences are linked to ASDs. Look at the parish records, and see the remarkable numbers for "socially awkward" young men disappearing, or turning up dead. If I had been born in 1751, instead of 1951, I probably would not have survived to the age of 15, when the last of 6 attempts on my life took place.

    We are now here more often because we are not being killed so fast! Not complex reasons, or chemicals, or anything else, ...just normal behaviors in a species of large obstreperously violent primates. This is so, even if it makes us all uncomfortable. Neurotypicals *do*not* like thinking their ancestors may have been, "like that". Auties don't like realizing how close to the edge they still live, ...but reality often isn't at all comfortable.
    Tom Billings
    IF there really is a real increase in the number of people with autism, Tom Billings has the best explanation. It has also anecdotally been noted that autistic children often have "socially awkward" (ie, probably asperger) parents.