Tuesday, April 2, 2013

Headline: CDC Reports Rise in Autism Diagnosis

USA Today
 on 3/20/13 reported, "Rates of all forms of autism in the U.S. may be substantially higher than previously estimated, according to a new government report that found that 1 out of every 50 school-age children - roughly one on every school bus - has the condition." This is significantly higher than the 1-in-88 figure reported by a different government agency last year. 

According the article, study author Stephen J. Blumberg, a senior scientist at the National Center for Health Statistics, explained "The fact that the new study found such high rates implies that 'there will likely be more demand for (autism-related) services than we had previously thought.'" The higher figures "recorded in the new study suggest that officials are getting better at counting kids with autism - not that more have the condition, several experts said."

Getting better at counting kids with autism? Well, I suppose that would be one explanation.  But a curious one. Autism used to mean a very unsubtle and obvious condition in which a child has severe language, intellectual and social impairments and unusual, repetitious behaviors. Somehow, like bipolar disorder, the definition has gradually expanded like a hot air balloon, and now includes "milder, related conditions."

Whenever there is a major increase in “diagnosed” cases of any psychiatric disorder, there are a number of possible explanations for why this has occurred.  The condition supposedly being a genetic disease is never one of them, as the gene pool does not change radically in even 100 years, let alone 10 or 15 – Unless, of course, there is a widespread selective breeding program. I don’t think I’ve heard of anything like that going on, even in North Korea.

So what are the other possibilities? 

One is indeed that the disorder was not recognized as a separate entity for some reason. This actually happened with panic disorder, which is as real as the earth and the moon, and which is fairly common. Common, but for some reasons many psychiatrists even now don't ask patients if they have the symptoms. That phenomenon is rampant in the Veterans Administration Hospital.

For decades, patients would show up at hospital emergency rooms complaining that they were having a heart attack. Multiple tests would be performed including physical exams, EKG’s, and cardiac enzymes (proteins associated with the heart that increase when there is heart tissue damage). All the tests would come out completely negative for a myocardial infarction. 

Still, hardly anyone in psychiatry seemed to mention this until the 1970’s, and panic disorder did not become part of the diagnostic manual, the DSM, until the DSM-III in 1980. Perhaps it was because sufferers were quite sure that they had a physical abnormality and did not consult psychiatrists, and because ER doctors were too afraid to tell patients they might have a psychiatric problem for fear of being accused of thinking the symptoms were “all in the patient’s head.”

Possibility #2 is that there is a new environmental pathogen - a disease causing germ or pollutant in the food or in the air. AIDS comes to mind as an example – the virus did not spread from monkeys to humans until the middle of the last century in all likelihoond, and did not become commonplace in people, especially in the United States, until the early 1980’s.

A lot of people thought that the sudden explosion of ADHD in the States was due to new food additives. There turned out to be no convincing evidence of this, but a lot of people still believe it.

The third possibility is that there have been major shifts in the ambient culture which lead to conflict and confusion in families and which can, unlike the gene pool, change in relatively short periods of time. A good example is borderline personality disorder (BPD), a disorder of such magnitude and obvious psychiatric distress that it would have been nigh impossible for psychiatrists to miss. This is especially true because when it first began to show up in large numbers in the 1970’s, most psychiatrists were psychoanalysts with a major interest in personality.  

And yet the incidence of BPD exploded. Readers of this blog know that I have seen major changes in parenting styles and gender role functioning that I believe account for the disorder, with genetic make-up playing a decidedly minor role.

The last possibility is the one that I think is occurring here with autism, and it again will be quite familiar to those familiar with this blog. 

I must add the disclaimer that I do not treat children or autism myself, so admittedly I have no direct knowledge of what’s going on. But still I have seen some evidence.

The last possibility is that of disease mongering by pharmaceutical companies and mental health professionals, combined with parents looking for “biological” explanations for their acting-out children rather than face what might be going on at home within their family.

The main theme of this blog is that together these separate interests groups synergistically increase the rate of false diagnoses – the emergence of so called “spectrum” disorders which, the reasoning goes, simply must exist because some behavior being seen seems superficially similar to some aspect of a real disorder. That way mental health professionals get more business, drug companies sell more sedating drugs, and parents don’t have to look at their own behavior.

Another significant aspect of this process is indirect financial incentives: 1. Government officials looking at how common an illness or disorder is when weighing how to spend limited public health and research funds. This provides a financial incentive for researchers to find more “cases.”  2. People looking to get their kids on disability in order to receive government money have more behavior that they can coach their children to manifest in order to get their “crazy checks.”

So what’s the evidence that this might be happening with autism "spectrum"? Well first of all, the research on which the headline is based has a basic flaw. The data was collected from a phone survey of parents in 2011 and 2012, of which "Less than a quarter of the parents contacted agreed to answer questions." That 25% sample of parents might not be representative of the entire group of parents with children.  

Furthermore, if my speculation has validity, parents who did agree to participate might just have a strong desire to prove that their children have it by exaggerating their children’s behavior. Just sayin’.

Even more curious is that the biggest increase in autism diagnoses was in boys and adolescents aged 14 to 17. This is well beyond the age at which real autism should have been clearly noticeable. To me, this reeks of an increase in the prevalence of behavior problems, not an increase in the prevalence of a serious mental disease like autism.


  1. I'm sure you are familiar with, but I really think Dr. Gabor Mate has a lot of important things to say on the mechanisms that are contributing to rises in ADHD (e.g. societal stress coming into homes and lack of parent/child attunement/attachment (ie kids tuning out) (he's written several books, one just on Attention). e.g. A baby's only defense when needs not being met or alarmed is to 'tune out' and this can rewire brain to be in default mode as the child grows. Also Dr. Gordon Neufeld sees much of 'attention' problem as an underlying alarm-system (anxiety) issue, and he has some compelling theories about how this is developed. Fan of your blog!

  2. From About Diet Doctor's website. Interesting comparison of maps of ADHD, obesity, soda consumption and disease occurrence.

    Poor parenting skills (lack of knowledge?), coupled with poor diet = toxic children?

  3. Dr. Allen,

    I have very mixed emotions about this issue. I know many people with asperger syndrome in which there is no question the diagnosis is legitimate.

    On the other hand, I used to work at a special ed school in which it seemed if a student had one symptom of autism, they got the diagnosis when it was clear to me, they didn't have it. As an FYI, at least the students I worked with were not on meds.

    Now perhaps it was a funding issue but to me, at least in this case, it seemed more like a one size fits all type of diagnosing by professionals who don't seem to be comfortable with any type of ambiguity.