Autism Rising? Dr. James Coplan Says It Ain't So But Is He Right?

Dr. James Coplan,  a developmental pediatrician with four decades of experience with special needs children,  argues in Psychology Today that there is no increase in incidence of autism.  Dr. Coplan distinguishes between autism prevalence which he describes as rates of autism diagnosis and rates of autism incidence which he describes as rates of autism occurrence .  The essence of the Coplan autism epidemic denial has been heard before and is obviously partially correct. The  changes in diagnostic definitions of autism from the DSM-III to the DSM-IV have expanded dramatically the numbers of persons described as autistic. I agree with that observation and I don't know of anyone who disagrees with it.  The problem is that those diagnostic definition changes do not necessarily explain the entire, startling increase. 

Dr. Coplan does not really provide any credible argument or evidence to show that the entire startling, increase in autism diagnoses  results from the 1994 diagnostic changes.  Since my son was diagnosed 12 years ago (and his diagnosis is Autistic Disorder, assessed with profound developmental delays) the reported rates of autism, the autism prevalence as described by Dr. Coplan,  have literally skyrocketed. From 1 in 500 to 1 in 110 with the most recent increase from 1in 150 to 1 in 110 occurring over a two year period, long after the DSM-IV changes.  Dr. Coplan simply provides no compelling argument or evidence to support his rigid thinking that the increase is explained entirely by the diagnostic changes, increased awareness or the internet as some are now using to spice up the denial argument.

Another problem for Dr. Coplan is that he is not criticizing parents of autism children , celebrities, or doctors who do not follow medical "consensus"  with his argument. It is easy to mock, ridicule and belittle   a celebrity actress autism mom when defending the safety of vaccines (even though it is an irrational strategy which simply creates more suspicion of health authorities).  It is much more difficult to ridicule the CDC which compiles the autism prevalence rates. It is much more difficult to mock the IACC which has published information indicating that only about 40-50% of the increase can be explained by the 1994 diagnostic change and social ascertainment factors.

Another huge problem for Dr. Coplan is that his argument ignores any possible environmental factors as causes or triggers of autism disorders.  If autism incidence, rather than diagnosis, has remained constant than that supports the decades  old thinking that autism was entirely genetic; that no environmental factors were involved. That paradigm was never much more than an assumption to begin with but it is  now giving way to a new paradigm; one that views autism disorders as resulting from the interaction of genetic and environmental factors.  

That autism paradigm shift is remarkable in its own right given the fact that autism research funding has been directed overwhelmingly toward genetic research at the expense of environmentally  focused research.  In other words if you look at the sky you will see the sky.  If you look at the ground you will see the ground.  If you do genetic research .... well you will find that in 3% of cases studies persons with autism had common genetic processes all of which were unique to the individuals involved.  YUP after decades of genetic research that's all we got.  With a shift toward more environmental autism research we are likely to find more environmental triggers of autism disorders ... and more information to explain the startling increases in autism incidence.

This humble autism dad in small town New Brunswick, Canada does not need a distinguished pediatrician like Dr. Coplan to convince me that the DSM-IV expanded the numbers of those diagnosed  with autism.  And I agree with him that the DSM-5 will continue that expansion. A great danger of that future expansion is that the obsession with genetics will once again be supported by the inability to distinguished autism prevalence and incidence because of a new DSM change.  The environmental aspect of autism disorders, the environmental triggers of autism disorders, which may essentially be synaptic disorders, will be neglected and the real increase in autism incidence denied and obscured again.

Dr. Coplan's decades of pediatric experience should be respected and valued but they should also be seen as potential obstacles to new thinking, new paradigms and new evidence from credible authorities, like the CDC and the IACC. Researchers like Dr. Irva Hertz-Picciotto,  who has said that we need more environmental focused research to help us understand what is happening, should be heeded and their opinions valued.  We have to move to a new paradigm and abandon the old assumptions that autism is entirely genetic, that autism is not actually increasing, if we are to understand what is causing these autism disorders that may be synaptic disorders.

Autism Still Rising in Australia

According to the Australian Broadcasting Company News two new independent studies from Melbourne's La Trobe University indicate that autism is on the rise in Australia. Official Australian estimates of 1 in 160 are now being challenged by the two studies one of which reports an incidence of 1 in 119 persons affected by an autism spectrum disorder diagnosis. A second study from La Trobe using much smaller study group reports a 1 in 100 figure.

The usual "we don't know if the increase is real, or is the result of better diagnosis" stuff is quoted in the ABC News article. Maybe we should just assume that the increasing rates of autism in Australia, and elsewhere in the world, are due entirely to better diagnosis and increased awarness. Like the famous three monkeys we could cover our eyes and ears and ignore the autism epidemic.

Perhaps like Dorothy from the other Oz we can just click our heels three times and wish that autism were not actually rising, that there were no environmental factors causing increases in autism. Or maybe we could do the research necessary to determine what environmental factors are causing the autism increases.

We really don't need any wizards telling us it is all in our heads.

autism

Autism Surging - the Numbers Are Going Up

The Centers for Disease Control and Prevention is estimating 1 in 150 births will be affected by Autism. In fact, that number is growing at a startling rate of 10 to 17% a year.

"The numbers are huge and they're going up," said Dr. Phillip Demio, Autism Specialist.



http://www.thedenverchannel.com/health/13852467/detail.html

The arguments will continue about why the number of persons diagnosed with autism are going up. The arguments have been stated and restated many times and usually boil down to environmental toxins versus changed definitions and greater autism awareness. Bloggers, lawyers, cultural anthropologists and professors of english literature can foam and froth and offer their considered, or ill considered, opinions about why the numbers are rising but they are. In the UK the numbers are higher. Even Neurodiversity icon Simon Baron-Cohen begrudgingly cites 1 in 100 as the incidence figure for autism in the UK. To my knowledge no one has explained the divergence between the 1 in 150 US figure and the 1 in 100 UK figure. Hopefully though we will one day know what is creating the surge in diagnoses of autism disorder.

There is an explosion of research into the causes of autism now taking place. The Autism Knowledge Revolution is happening all around us and we should soon have more reports and more information from Boulder Colorado where the USAAA is holding its conference Treating Autism as a Medical Disorder; Bringing Biomedical Treatments and Behavioral & Developmental Therapies Together. Understanding the causes should help in the development of new treatments for autism. And someday conclude yet another seemingly endless autism debate.

Autism Surging but Why? The Jury is Still Out

Lost in the hoopla over the Wakefield hearing in the UK and the "Vaccine trials" in the US are the increases in reported cases of autism in various parts of the world. The US reports have increased to 1 in 150 and the UK reports, by no less an authority than Simon Baron-Cohen himself, a 1 in 100 incidence of autism. Obviously some of those numbers are attributable to the changes in the DSM and in better awareness, diagnosis and reporting. But while everyone is aware of those factors no serious study or report actually attributes the entire increases in the incidence in autism to these factors alone, Baron-Cohen's opinion, and that of Neurodiversity bloggers notwithstanding.

The graph from the California Department of Developmental Services shows that reported incidence of autism increased by five times in the ten year period from 94 to 04. Undoubtedly the DSM change would be a substantial factor in that startling increase along with better awareness, diagnosis and reporting. But do environmental factors contribute to the increasing incidence of autism and if so to what extent? This is a serious question which is not answered by self assured opinions from Baron-Cohen. The medical tribunal will soon report its verdict on Mr. Wakefield and the US "Vaccine Court" may offer some insight on vaccines and thimerosal but as to environmental factors generally the jury may well be out for some time to come.