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Tuesday, June 5, 2012

An Inaccurate Article on Autism

At Investor's Business Daily, Paul Sperry writes about "autism hysteria."
In 1994, medical officials and the Clinton administration broadened the definition to include children who previously might have been thought of as odd.

Today milder conditions, such as speech impediments and extreme shyness, are covered in addition to severe autism under the new umbrella: Autism Spectrum Disorder.
Apparently, he is referring to DSM-IV, a product of the American Psychiatric Association, not the federal government.  On the one hand, it is true that the DSM-IV criteria expanded the number of people who would qualify for a diagnosis of autism.  On the other hand, the criteria make no mention of "shyness" or "speech impediments."  Rather, the manual refers to impairments in communication and social interaction, which are different. In any case, no single impairment is sufficient for a diagnosis.
Now more than half of autism cases fall under the mildest range of the spectrum, known as Asperger's disorder. These kids fidget. Or brood. Or they may pick their nose and eat only yellow foods. But they are high-functioning students who will be able to hold jobs as adults.
"More than half" seems to refer to the recent CDC study:

Description: Data Chart 2

But it is preposterous to suggest that all those with PDD or Asperger's are "high-functioning students who will be able to hold jobs as adults."  Studies have shown that they have extremely high unemployment.  Many are in day services or not engaged in productive activity at all.
A growing body of scientific research has found that the rise in autism diagnoses is not due to a true increase in the incidence of the cognitive disorder, but rather to a widening of the definition and increased screening by schools and doctors, who are rushing to diagnose and medicate socially awkward or difficult kids.
Again, there is no real controversy as to whether the widening of the definition contributed to the apparent increase in prevalence.  But there is no consensus as to whether there has also been a true increase.  Indeed, there is serious research indicating that change in diagnostic criteria do not account for all of the increase.
As of December 2010, the latest Social Security Administration data show, almost 100,000 children were on federal disability for autism. Parents filed 23,203 new applications in 2010, quadrupling 2000's total of 5,430.
These figures come from a Government Accountability Office report on Supplemental Security Income, not federal disability insurance.  The report indicates that the increase comes from people who would have previously had the classification of intellectual disability (the old term was "mental retardation")
Between fiscal years 2000 and 2010, autism applications more than quadrupled from 5,430 to 23,203, and medical allowances increased similarly from 5,050 to 20,319 (see fig. 6). As of December 2010, about 95,000 (11 percent) children with mental impairments were receiving SSI benefits due to autism. DDS examiners have generally found the vast majority of those children applying for SSI on the basis of autism medically eligible for benefits. SSA officials attributed the increase in the number of autism applications and medical allowances over the years to greater incidence of autism among children and explained that some children who may have previously been diagnosed as intellectually disabled are instead being diagnosed as autistic. According to one study SSA cited, the prevalence of autism in children has increased from 0.6 per 1,000 live births in 1994 to 3.1 per 1,000 live births in 2003, while the prevalence of intellectual disability decreased by 2.8 per 1,000 live births in 2003.
In other words, a lot of these kids would have been receiving services anyway -- just the wrong kind of services.