Here's some evidence supporting the idea that the increase in autism diagnoses is just that — an increase in diagnoses, not an increase in incidence. Increases in autism diagnosis aren't evenly spread around the country. There are hotspots. Researchers found that kids who move into these hotspots — even after an age where autism might have been normally diagnosed — have a higher likelihood of being diagnosed with autism than kids to didn't. It suggests that awareness and resources might play a big role in rates of autism diagnosis. (Via Micah Allen)

31 Responses to “Epidemic, or awareness?”

  1. jandrese says:

    One thing that concerns me about the increase in diagnosis is that suddenly all of these kids are labeled as having a “condition”.  For the severe cases this is certainly true, but most of the autistic kids I know are fairly mild.  The problem is that once you have a condition, it’s very easy for people’s behavior to become self reinforcing and make the problem worse.  You have a person who was going to be shy and awkward around other people for the rest of his life, but otherwise able to hold a job, have a family, etc… who now is special and needs special treatment because they are special.

    I guess a lot of this is aggravation at the parents, who were already borderline helicopters before they learned that their child was “special”. 

    • Marja Erwin says:

      And if you are autistic and aren’t diagnosed, you might not learn how to navigate the bullying, harassment from teachers, beatings, demands for eye-contact, sometimes sensory issues, sometimes coordination issues, sometimes headaches due to the strobing of the fluorescent lights, and so on. And the bullying, harassment, and beatings can leave you with ptsd which won’t help you in daily life.

      • Antinous / Moderator says:

        As someone with a rare congenital condition, I’m much happier knowing why I have problems than being labeled a slouch and a malingerer. Oh, and I can use that knowledge to prevent further deterioration.

    • Simon Péter says:

      That would make more sense if clinical “special treatment” would consist of locking away high-functioning kids and coddling them like incapables, as opposed to paying more attention to their hardships and making sure that they will actually be able to hold a job, have a family, etc. in spite of their condition. 
      Autism is an in-born neurological condition, not a lifestyle choice. The recently common idea that it is just being “promoted” too much nowadays,  and it could be cured if only it would be hidden in a closet, is just as cringle-worthy as the implied parallel. 

    • Snig says:

      You’re likely unaware you’re self selecting the population you’ve observed.  The folks with more than mildly autistic kids don’t find it as easy to socialize.  You don’t see them.  I know many, many parents with a wide variety of degrees of autism, as well as many parents of only typical kids and don’t  see a correlation between parenting ability, mildness or presence of autism.  

      Edit to add an apt quote from a John Wayne movie, Fort Apache:
      Lt. Col. Owen Thursday: I suggest the Apache has deteriorated since then, judging by a few of the specimens I’ve seen on my way out here.
      Captain Yorke: Well, if you saw them, sir, they weren’t Apaches.

    • l3580xxx says:

       As a diagnoser of autism I think you’re wrong. THe lay-press may approach autism as a ‘condition’, some sort of lesion that is separate from the entire biological and psychoscoial context of the child. For most child psychiatrists however we simply see the diagnostic term as an economical way to describe a set of behaviours, likely pattern of learning, and easy way to direct funding/appropriate educaitonal supports to certain children. Kids with this ‘label’ in my experience do not end up in some sort of self-fulfilling autism prophecy consequent in disadvantage. They are more often than not kids who are having a lot of trouble who can benefit from the help. You are right that those troubles are not part of some coherent neurobiological pathology that is called ‘autism’, rather they are experiencing trouble which arises form the complex interplay of neurological capacity and social environment (as with every mental illness). In Australia at least, naming the trouble ‘autism’ usually just directs the appropriate actions by parents and teachers.

      As for the title of this post, no shit sherlock. I have seen this even when certain psychiatrists move from one suburb to another. Suddenly nearby schools have outbreaks of autism. Doesn’t mean those children aren’t worthy of the diagnosis or the help it dictates, just that before they received neither the diagnosis nor the support.

  2. awjt says:

    If not ADD/ADHD then PDD/NOS.
    If not PDD/NOS then Asperger’s.
    If not Asperger’s then Autism.
    If not Autism, then Toxic Mold.

    It’s always been this way.  Until there is a better system of following medical practices and universalizing the system, diagnosis is subject to a geographic signature phenomenon. We call it variation.  Some variation is natural.  Variation that moves too far left or right needs to be examined.  What’s worse, iatrogenic disease is probably the hardest one to eradicate.  Iatrogenic=doctor-caused.  But doctors are overall *good* and yet there is so much more to know about human medicine.  Paradox abounds.

  3. Jim Schmidt says:

    My son’s not been formally diagnosed as autistic, but having “autistic tendencies”. This includes an utter unwillingness to acceed to requests to do homework, or clean up after himself, or turn off the lights, as well as occasional bursts of furious flailing rage when he’s asked to do things that affect his routine (i.e. interrupt his video games). Thankfully, he knows and understands that hitting people is wrong. He’s in counseling for the ragey stuff now. He’s very bright, very empathetic, and very lazy, just like me.

    I was never diagnosed as anything when I was a kid, but it occurred to me recently that my inability to keep eye contact with someone is an indicator of autism. Combine that with my past-any-useful-reason stubbornness and “family temper”, and I wonder diagnosis what could have been hung on me.

    • wysinwyg says:

      FWIW, I have the “trouble making eye contact” thing too.  My father who is pursuing a Ph.D. in clinical psych assured me when I asked that he wouldn’t even consider an autism Dx in my case because (even with the lack of eye contact and general shyness) he notes that I have a dynamic emotional affect when I interact with other human beings — I can figure out how they’re feeling and respond appropriately.

      But I’ve always been introverted/shy whatever.  I tend to think you can end up with a few symptoms of autism through social conditioning (or lack thereof) even without having the emotional/social disconnects that usually cause such symptoms.  (I also had the problems with procrastination/not doing homework/not cleaning up after myself.)

  4. anansi133 says:

    One high-functioning autistic person I’ve spoken to says she was 16 or so before she ‘woke up’ and started remembering the way she does now. The way she says it, an autism diagnosis either didn’t happen, or was not taken into consideration during her upbringing.. There was clearly something different about her, and that difference became a problem.

     So my question is, what diagnoses were being given to these kids before they were diagnosed with autism? It’s not like bad hearing or poor eyesight that can be ignored until they’re an adult.

    • Marja Erwin says:

      Supposedly, Martin Luther diagnosed one such kid as lacking a soul. One might wonder who lacks empathy.

    • CH says:

      “So my question is, what diagnoses were being given to these kids before they were diagnosed with autism?”
      For milder cases I would guess a diagnosis of lazy, stupid, uncooperative, bad kid, bad parenting, if-you-just-applied-yourself… I would guess only the most severe cases would have gotten an actual diagnosis. And I would also guess a lot would just have gotten a “developmentally delayed” diagnosis.

      “It’s not like bad hearing or poor eyesight that can be ignored until they’re an adult.”
      I would say poor eyesight or hearing had a much, much better chance of being caught than any psychiatrich/neurological issues. I don’t know one kid who had an ADD/ADHD diagnosis when I was a kid, although I’m pretty sure about at least a handful that they must have had it (including me)… but we were just bad/lazy/bad parenting/if-you-just-applied-yourself…

  5. Øyvind says:

    And what about kids that “conveniently” get a diagnosis because the parents are unable to cope with them? Poor parenting replaced with medication? Does that have hot spots too?

    • Neural Kernel says:

      What medication is that? You want medication, you need your kid diagnosed with something like ADHD, Depression, Anxiety… not autism… that’s a diagnosis that comes with NO drugs… pretty much the exact WORST diagnosis if you want your kid chemically modified…

      • Øyvind says:

        I’m sorry, it was a poorly formulated post. I should have said diagnosis instead of medication.
        My point was that some things (like the ones you mentioned) have a tendecy to be over-diagnosed. And my question is whether that goes for autism as well. Because then you’ll get access to a support system (in some places, anyway), and the parents can rest assured it’s not their fault, it’s a condition.
        I’m not saying it IS like that, just that some would probably find it easier or more convenient if they could ascribe their child’s behaviour to something other than themselves.
        But I guess we might get a chance to see. I noticed Asperger will no longer be included as a separate diagnosis in DSM-V. So it’ll be interesting to see if the autism diagnosing then skyrockets.

        • CH says:

          And it’s so much easier for the “outside world” to ascribe kids who are behaving strangely or badly as bad parenting. It seems to be _incredibly_ hard to actually consider that the child actually has a psychiatric or neurological issue… no matter how much the parent waves the diagnosis right in front of the nose. Nope… bad parenting.

          But sure, hobby psychologists are much better at diagnosing than professionals, at least when the diagnosis is “bad parenting”.

    • Snig says:

      I know a ton of parents who had there kids diagnosed with autism.  Almost all of them, self included,  fought against getting their kid getting that diagnosis.  My daughter is better behaved than many typical kids.  She’s on no meds, though we tried a bunch and found they made no difference.  Many parents with multiple kids have some kids with no issues, and some with severe autism.  Nothing about my daughter having autism has been convenient.  Unless you’ve parented the exact same kids and have resolved that kids issues, it’s pretty ballsy to assume that you’d do a better job. 

  6. teapot says:

    Maybe those hotspots merely correlate with places with a higher incidence of vaccination, amirite?

    </troll>

  7. RJ says:

    Part of me agrees that autism diagnoses are on the rise due to awareness. Another part of me thinks it’s all wrong, and that the majority of these diagnoses are being applied to children being traumatized by their sociopathic parents. Sociopaths are incapable of empathy, so they’re incapable of connecting to their own offspring in a way that would facilitate well-adjusted development. So the child withdraws and escapes into their own world. From the outside, they seem odd and distant. Maybe they avoid meeting others’ gazes because they’ve learned from an early age that looking someone in the eye is an invitation for punishment.

    I’m not qualified to say all that with authority. I just wonder how many of these autistic kids are actually autistic, and how many are simply presenting autism spectrum symptoms while dealing with something entirely different.

    • Antinous / Moderator says:

      Besides the fact that your etiology is completely unrecognized by medical science, do you actually know any autistic people? Are their parents sociopaths?

      • RJ says:

        Of the autistic people I’ve met and associated with over the years, I can think of at least two (and possibly a silent third) who were institutionalized as a way to get them out of their parents’ hair when they clearly were either high-functioning or not apparently autistic. It isn’t surprising when you consider that parental rejection is far more common than autism.

        Calling such parents “sociopaths” may have been rash. Then again, it may have been accurate. Like I said before, I’m not qualified to say.

    • Thank you, Dr. Bettelheim, for informing me that I’m a sociopath! Me and “the majority” of parents like me! I had no idea that those of us who have been struggling to help our kids for years or decades had actually been punishing them all along for their innocent attempts at eye contact. God, I’m a beast. But maybe I hadn’t noticed because of my lack of empathy. Obviously, I would find it hard to say.

      What an enlightened comments thread this has been. At the top it’s the fault of parents because they’re hovering helicopters, and at the bottom it’s the fault of parents because they’re sociopaths. I thought Boingers got out more.

      • RJ says:

         You’re acquainted with the majority of autistic people’s parents? That’s amazing. How do you find the time for your own family?

        Your comment centers around what a trooper you are, and how wrong it is to question the widespread autism diagnoses, these days. Questioning these diagnoses – or ANY diagnosis of ANY kind of permanent condition – is what helps keep people from abusing the system. It’s what helps keep people like you and your child from being without any legitimate professional help. So cut the histrionics already.

        • Snig says:

          I’m sorry you’ve lived a life that made you snap to the judgement that kids with problems have sociopathic parents.  My first response was anger, but on reflection, I’m guessing you wouldn’t jump to that without some personal reason.

          Most parents take their kids to several doctors, looking for an answer that isn’t autism.  We did. An autism diagnosis is never something we sought.  I don’t know anyone else who was seeking that diagnosis.

          Parents of kids with autism tend to hang around other parents of kids with autism because their kid’s behaviors tend to isolate them.  There tend to be fewer and fewer invitations to playdates, there aren’t friends or neighborhood kids who come by to see if your kid wants to play.  So, yeah, I know several dozen parents of kids with autism, because when we’re not at our sociopath’s social circle, we tend to socialize with other folks who have kids with special needs.   Of these, I know of only one parent who had her kid institutionalized, that was when he was sixteen and was repeatedly violent to her and everyone else.  He wasn’t toilet trained, but maybe you think it was an elaborate ruse?  Maybe she gave herself the black eye.  I’ve also worked with many survivors of childhood sexual abuse (teaching self defense), and can say that I knew many who were warm, empathetic, social people, so I don’t think autism is neccesarily a inevitable response to abuse.

          You seem to want to judge a lot of people who aren’t neccesarily having an easy time of it.  I doubt Christine was looking for a medal, but basic human decency and a lack of abuse would be nice.  Consider the possibility that there are loving parents who would give there right arm for their kid to be happy.  Some of these parents have kids who turned out to have autism.  Some folks have quit their jobs to spend their days with their kids, some have gone bankrupt getting therapies.  Now imagine them reading your comments and how they would feel.

        • Antinous / Moderator says:

          Your initial comment was pretty heinous. You’re the one who made the insulting assumptions about people who, on the whole, are doing the best that they can in difficult circumstances. Telling someone else to ‘cut the histrionics’ is rather ironic.

        • aikimoe says:

          Yeah, you’re pretty much being awful right now.  Your first post was as reality based as “chem trail” theories and remarkably insensitive.

          Lots and lots of people are able to question diagnoses without straying into a pointlessly insulting, hyper-subjective fantasyland.

    • B E Pratt says:

       I found out only when I was something like 12 or 13 that I never could look anyone in the eyes. Well, not without a lot of thought about it. My sister abruptly ended a shouting match by screaming, “Why don’t you ever look me in the eyes!!” I was was stunned mute with that. Turned out that due to my poor hearing, I was hardwired to look people in the mouth. Sometimes lip reading could help me figure out what people were saying. Course, being near legally blind (nearsighted) didn’t help either.

  8. Snig says:

    On Thursday, you discussed leaded gasoline as being a potential neurotoxin that had wide ranging effects on society lasting about two decades.  Lead is a pretty straightforward toxin. An unknown putative candidate leading to increased autism incidence doesn’t have to be as simple.  It’s odd to me that the article and you don’t seem to take this into serious consideration.

    • wysinwyg says:

      Not every article can be about everything.  Notice that the lead article didn’t spend a whole lot of time on the abortion thesis it attempted to rebut.

      Edit: From the blog post linked in the OP:

      It’s not proof. You could argue that there’s some toxic chemical, say, present in the rich parts of L.A. that causes autism, even if you move into the toxic area only at age 3 or 4, and that’s been getting worse recently, leading to rising rates.

      • Snig says:

        That’s fair.  I’ve a personal investment and a biochemistry background so I may be seeing lines that aren’t there.

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