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Tuesday, April 24, 2012

Allen Frances on Changes in Prevalence

Dr. Allen Frances edited DSM-IV and blames himself for the "epidemic of Asperger's."  He has argued that the increase in prevalence is an artifact. He sums up his views in the New York Post.
That unexpected jump has three obvious causes. Most important, the diagnosis has become closely linked with eligibility for special school services.
Having the label can make the difference between being closely attended to in a class of four versus being lost in a class of 40. Kids who need special attention can often get it only if they are labeled autistic.
The second driver of the jump in diagnosis has been a remarkably active and successful consumer advocacy on autism, facilitated by the power of the Internet. This has had four big upsides: the identification of previously missed cases, better care and education for the identified cases, greatly expanded research and a huge reduction in stigma.
But there are two unfortunate downsides: Many people with the diagnosis don’t really meet the criteria for it, and the diagnosis has become so heterogeneous that it loses meaning and predictive value. This is why so many kids now outgrow their autism. They were never really autistic in the first place.
A third cause has been overstated claims coming from epidemiological research — studies of autism rates in the general population. For reasons of convenience and cost, the ratings in the studies always have to be done by lay interviewers, who aren’t trained as clinicians and so are unable to judge whether the elicited symptoms are severe and enduring enough to qualify as a mental disorder.