Autism has been a controversial and confusing condition for parents, school teachers and health providers in recent years as guidelines for diagnosis have changed and the number of cases has soared. Why are there more autism cases among children now? What reasons are behind the change in diagnosis guidelines?
Autism is a condition that affects a child’s development and shows up with a wide range of emotional and learning difficulties. A child with autism may have difficulties with social interactions and communication. They can also fall behind on standard development metrics at an early age. The causes of autism are unclear and are mostly described as occurring before birth. Doctors stress that the causes do not include any parenting factors.
No More Sub-Categories
Before 2013, there were four sub-categories of autism, which encompasses a wide range of development problems. However, the American Psychiatric Association (APA) revised the Diagnostic And Statistical Manual of Mental Disorders such that the four types were eliminated.
The changes were made, the APA said because the condition is diagnosed by a physician’s understanding of a young child’s behaviors as compared to normal development. Behaviors, however, are often hard to quantify and the APA said that the diagnosing had become inconsistent. Having one category allowed diagnosing to occur with better consistency.
Cases On The Rise
Even now the rise of autism cases is attributed to uneven diagnosing combined with a growing awareness of the disorder. Also, the services available to special needs children have grown and improved, making it advantageous for parents to have a diagnosis that can improve a child’s chances of receiving more help in school.
A clear sign that indicates diagnostic inconsistencies is in the data. In Colorado, 1 out of every 93 children is diagnosed with autism, while in New Jersey 1 out of every 41 children are diagnosed as autistic. Meanwhile, the U.S. Center for Disease Control and Prevention (CDC) calculates that 1 out of every 68 children was diagnosed with autism in 2008, which is up more than 100 percent since 2000.
There is also a split between genders, as boys have a higher risk of autism compared with girls. Among boys, 1 out of every 42 is diagnosed with autism, while among girls, the number is 1 out of every 189, making boys four times more likely to be diagnosed than girls.
Signs of Autism
Standard development metrics describe typical behaviors in numerous ways. With autism, the following atypical behaviors include:
- Lack of showing recognition for faces
- Inability or lack of effort in making eye to eye connection
- Flat affect in response to a mother or father’s smile
- Slow verbal development (including the inability to say any words by the age of 14 months)
- Lacks the standard behavior of pointing to objects (generally done by pointing to or showing a toy to siblings or parents)
- Lack of empathetic response
- Word repetition (copying what others say exactly while showing no understanding of the words or phrases
- Has difficulty with pronouns, such as “you” and “I”
- Lack of effort to communicate
- Exhibits a precocious focus on a variety of stimuli, including advertising jingles, baseball scores, mathematics, which indicates a high competence level in very specific topics, without consistent learning across the board
- An exaggerated emotional response
- An exaggerated negative reaction to various stimuli, including touch and sounds (such as music)
- Inappropriate or atypical facial expressions while responding to stimuli
- Inability or lack of effort in initiating contact with others, starting a conversation or focusing on one, and other social interactions
As you can see, diagnosing autism in a very young child can be subjective and include a few “gray areas” that prompt an uncertain diagnosis. Tracking these behaviors over time, however, can give physicians and parents a better indication of whether or not a diagnosis is indicated.
Autism is diagnosed by comparing a child’s behavior to standard development factors, some of which are calculated for children at a very early age. At two months of age, for example, most children will smile at their parents, while a child with autism typically does not.
Meanwhile, most doctors hesitate before diagnosing a toddler simply because more traits of autism could show up later and the differences in services at that age are minimal. Many doctors have a “wait and see” approach to making a diagnosis at that age, nevertheless, some of the behaviors could show up that early.
Behaviors associated with autism
The latest estimate of autism prevalence—1 in 68—is up 30 percent from the 1 in 88 rates reported in 2008, and more than double the 1 in 150 rates in 2000. In fact, the trend has been steeply upward since the early 1990s, not only in the U.S. but globally, says Maureen Durkin, who heads the network site in Wisconsin.
An indication that the method is imperfect is the fact that autism rates vary dramatically between states. The prevalence in Colorado, for instance, is 1 in 93 children, whereas in New Jersey it is 1 in 41. It is unlikely that the rates naturally vary that much between states, Fombonne says. Instead, the difference probably reflects varying levels of autism awareness and of services offered in those states.
“The previous labels were applied very unevenly and did not separate subgroups in a reliable or meaningful way,” says Jeremy Veenstra-Vanderweele, MD, director of child and adolescent psychiatry at Columbia University College of Physicians and Surgeons in New York City. “Depending on where someone went for an evaluation, they might walk out with a different diagnosis, even though the recommendations for treatment might be the same.”
Until 2013, there had been four separate diagnoses within the category of autism: autistic disorder, Asperger’s syndrome, childhood disintegrative disorder, and pervasive developmental disorder (PDD-NOS). The change was made because these distinct diagnoses were not always made consistently and may have limited treatment options for some individuals on the spectrum.
The American Psychiatric Association’s (APA) revision to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in May 2013, did not include four subtypes of autism. According to the DSM-5, anyone on the autism spectrum should be diagnosed simply with an autism spectrum disorder. “The revised diagnosis represents a new, more accurate, and medically and scientifically useful way of diagnosing individuals with autism-related disorders,” the APA noted in a statement released with the DSM-5 revision. (2)