By Deborah Jeanne Sergeant
The prevalence of autism spectrum disorder (ASD) was about one in every 150 children in 2000. Currently, it’s about one in 59, according to the Centers for Disease Control and Prevention.
So why do so many more children have a diagnosis of ASD?
While some people might look at the issue and think that some outside factor is causing more children to have ASD, experts look to other reasons for the increased rate.
“There are many reasons for the increase in the diagnosis, some of which are the inclusion of a broad range of phenotypes or symptoms from very mild to very complex,” said pediatrician Michelle Hartley-McAndrew, medical director at Children’s Guild Foundation Autism Spectrum Disorder Center at Oishei Children’s Outpatient Center.
She said that “the increase in diagnosis of individuals with other genetic disorders such as Fragile X or Down syndrome contributes to the increase — as well as the fact that autism spectrum disorder diagnosis sometimes includes what used to be diagnosed as intellectual disability.”
Increased availability of interventions has also led to a greater number of diagnoses.
“More people may seek a diagnosis when it is required to obtain support and health services,” said Hartley-McAndrew, who is also a clinical associate professor of pediatrics at University at Buffalo Jacobs School of Medicine and Biomedical Sciences.
“At times, there may be over diagnosis when autism symptoms are not consistent at a young age and then as the children grow up their symptoms may lessen or disappear to the point where they may no longer meet the criteria for a diagnosis of autism spectrum disorder.”
As Hartley-McAndrew alluded, one of the reasons for the uptick in diagnoses is the broadening of how members of this population are described. Published by the American Psychiatric Association, the Diagnostic and Statistical Manual of Mental Disorders (DSM), represents mental health professionals’ book of officially recognized psychiatric disorders.
“They removed some subcategories,” said Tracy A. Panzarella, licensed speech-language pathologist and director of clinical services with Autism Services, Inc. in Amherst. “Now it’s ‘autism’ and varying levels under that. Many years ago, there were different labels. There was a continuum and terms like ‘high functioning’ or ‘childhood disintegrative disorders.’”
Though Panzarella doesn’t know why the terms were removed, she sees some merit in making the changes, since even under the former labels, it was all still ASD. Using “ASD” as an umbrella term is simpler, especially for children with multiple, overlapping and numerous traits difficult to label.
“Over the years, the statistics have definitely changed considerably,” Panzarella said. “We’re not sure if more doctors are on the look-out for more early warning signs.”
Insurance companies are covering more early intervention services because research indicates that “the more services they can get early on, the greater strides you’ll see the child make and more independence the child will have on down the road,” according to Panzarella.
No definitive, objective test exists to indicate whether or not a child has autism. Instead, providers consider a child’s developmental milestones, such as fine and gross motor skills, any sensory disorders and things parents have noticed that are different about their child compared with neuro-typical children.
Panzarella said that some adults on the spectrum who were previously diagnosed as having Asperger’s still prefer the term as they view it as a cultural, social distinction that better defines their experience.
Thanks to greater awareness and acceptance of autism, more community agencies and resources have been made available to help parents of children with autism spectrum disorder and the community in general better understand autism.
“Even 30 to 40 years ago, there wasn’t as much information as readily available,” Panzarella said. “There’s so much more information out there and it’s accessible to people so they can educate themselves.”
But Panzarella isn’t sure if some other factor is increasing incidences of autism to some degree as well.
“We don’t really know what causes autism,” she added.
What is Autism?
Autism is a neurologically based developmental disability that lasts throughout a person’s lifetime. It is a spectrum disorder that is characterized by social and communication challenges, sensory impairments, restricted behaviors and interests, and associated medical issues. Autism spectrum disorder (ASD) varies widely in severity and symptoms and may go unrecognized, especially in mildly affected children or when it is masked by other more prominent disabilities.
Autism is not a mental illness, bad behavior, caused by vaccines, or always associated with cognitive impairment.
If you see any of these signs in your child, be sure to inform your child’s pediatrician:
• no babbling or pointing by age 1
• no single words by 16 months or two-word phrases by age 2
• no response to name
• loss of language or social skills
• poor eye contact
• excessive lining up of toys or objects
• different social responsiveness than other children
These behaviors have been observed in older children:
• impaired ability to make friends with peers in expected ways
• impaired ability to initiate or sustain conversation with others
• stereotyped, repetitive, or unusual use of language
• restricted patterns of interest that are abnormal in intensity or focus
• inflexible adherence to specific routines or rituals
• Lack of fear or danger awareness
• Sudden (to you) changes in mood or demeanor
• Dislike of being touched/touching too much
• Not responsive to verbal and nonverbal cues
• Difficulty expressing needs or responding to questions
A developmental evaluation is required to diagnose a child with ASD.
From the website of AutismUp (www.autismup.org).