Well, the word went out far and wide yesterday. The prevalence of autism is now officially 1 in 88 in general, and 1 in 54 for boys in the US. For the past couple of years, we were hearing numbers like 1 in 110 for the general population. That sounds like a lot. And it is. But I always remember that my family has a sixty-six percent rate of prevalence. So in one sense, one in fifty-four sounds like child’s play!
Anyway, here’s my take on it.
1. Much of the rise is accounted for by underserved populations, such as blacks and hispanics, finally getting appropriate treatment. So these numbers don’t only tell us that so many more people have autism than did twelve years ago. Rather, we are beginning to see how many have had it all along.
2. Much of this also reflects a natural cycle. That is, the more awareness increases, the more likely a psychologist or psychometrician will be to consider ASD when treating someone. So more kids who were once labeled ADHD or specific learning disabled are now being recognized as actually falling under the autism umbrella because of the constellation of deficits they manifest. (In a future post, I will tell how our oldest boy, Michael, was just diagnosed with ASD two years ago, even though we suspected something was up with him for years.) A lot of adolescents and even adults are now falling into this category, leading to a spike in the number of diagnoses.
3. The jury is still out on environmental causes, such as junky diets, poor air and water quality, and an increase in other toxins in our over-processed, post-industrial age. We know that vaccines do not cause autism, but it’s likely that there are many contributing factors. We do know, for instance, that there is not just one “autism gene.” Not for nothing is it called a complex neurological disorder. So it’s also possible that more kids are being born with autism, even as more of those who have been with us for a while are being identified.
These three factors make a lot of sense to me, and they all help me accept the CDC’s numbers. But there are a couple of other things to keep in mind.
4. There’s the fact that this is a government agency, and the government is often reluctant to acknowledge epidemics, for economic reasons.
5. The DSM-5, which is due to be released next year, changes and in some ways narrows the criteria for the diagnosis. This could result in a decrease of the officially recognized cases of ASD. The joke going around is that the American Psychiatric Association is out to “cure” thousands of people of autism with the stroke of a pen! But just as the DSM-IV ‘s 2000 update broadened the diagnostic criteria quite a bit–contributing to the dramatic increase in recognized ASD cases some people stand to lose their label next year–and with that the services and insurance coverage that they have long relied on to help them navigate an unfamiliar neurotypical world.
All these factors combine to tell me that we are indeed in the midst of an autism epidemic.
That may sound extreme, but I am convinced that there’s a lot more of it out there than we’re willing or able to acknowledge. Think, for instance, of all the people in our penal system who are there because of developmental deficits or mental health issues. Never diagnosed, they are just locked away out of sight and deprived of any chance at proper treatment. But that’s for another post.