Saturday, February 02, 2008

Autism Rising in Alabama, from Huntsville, Alabama, reports statistics from an Alabama state task force report which says that the number of children in Alabama's public schools diagnosed with autism has grown from 68 in 1990 to 849 in 2000 and to 2,297 in 2006. Those who accept, as an article of faith, that there are no environmental factors in the worldwide increases in autism will immediately point to the changes in the DSM diagnostic criteria and definition of autism, increased awareness, and families seeking access to services by seeking an autism diagnosis for their children, as the sole explanation for such an increase. Some of these arguments are undoubtedly valid explanations for explaining part of such increases.

The changes in definition of autism began primarily in 1994 with the DSM-IV the last major revision of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. Some will argue that those changes did not have any impact for a couple of years afterward and that makes sense. But that argument does not explain the dramatic increase, the tripling of reported autism diagnoses in the Alabama report between 2000 and 2006. Here in New Brunswick Canada my son was first diagnosed with an autism disorder in 1998. The DSM changes were reflected in practice in this area at that time. By early 2000 there had been major reviews of Autism Disorders conducted in California, New York and Maine and by the office of the US Surgeon General. The definition changes and awareness arguments do not seem to offer much explanation for the nearly tripling of autism diagnoses amongst Alabama school children between 2000 and 2006.

Nor does the "parents pushing for autism diagnoses to obtain services for their children" argument, provide any assistance in explaining the Alabama increases between 2000 and 2006. The recent Alabama autism task force report recently reported that Alabama lacks the autism services offered by nearby states and across the United States.

The dramatic increase, the near tripling, of autism diagnoses amongst Autistic school children between 2000 and 2006 should raise serious questions about a possible environmental factors in contributing to such increases. Smug assumptions to the contrary are simply not based on evidence or sound reasoning.


Anonymous said...

You have obviously never been to Alabama if you can't wrap your mind around the fact that the state is often behind the curve on nearly every social and educational level compared to the rest of the nation. Mississippi will be next, but it will take a few more years.

Unknown said...

anonymous 8:00 am

My comment is about the nearly tripling of autism diagnoses in Alabama between 2000 and 2006. How does your comment relate to that?

Anonymous said...

Awareness (education) and lack of medical services is most likely the reason for the growth in autism diagnosis in Alabama. Alabama has typically trailed the rest of the US when it comes to health care, thus, I'm not surprised that there simply hasn't been the resources available to diagnose children.

Statistics from the US Health and Human Services Agency on Alabama:

There were more than 7,200 active patient care physicians in Alabama in 2000. With 162 physicians per 100,000 population, Alabama fell well below the national ratio of 198 physicians per 100,000. Alabama ranked 41st among states in physicians per capita.

Alabama had 57 active primary care physicians per 100,000 population in 2000, lower than the rate of 69 per 100,000 for the entire country.

The number of physicians in Alabama grew 43% between 1989 and 2000, while the population grew only 10% over this period, leading to a net per capita growth of 30%, higher than the national per capita increase of 17%.

Medical schools in Alabama graduated 217 new physicians in 1999-00. Alabama ranked 25th among the 46 states with medical schools in number of medical school graduates. On a per capita basis, Alabama graduated fewer new physicians per 100,000 population (4.9) than did the entire United States (6.4) and ranked 30th among the 46 states with medical schools in medical school graduates per capita.

There were 453 physician assistants practicing in Alabama in 2000. This was equal to 10.2 physician assistants per 100,000 population, lower than the national rate of 14.4.

Anonymous said...

Good Morning H,
I don't think (or at least I hope) that researchers are abandoning the search for possible environmental links to this drastic increase. Even the issue of Vaccines will continue to be examined for years until there is absolutely no doubt that there is no such link (we are far from that point). As I read other forums (not yours) what saddens me is the belief by many people that researchers have already made up their minds or have a particular agenda about proving that there is no environmental link. This is a misconception of how research works. For example the finding of a genetic link does not deny the possibility that an interaction with an environmental factor occurs, unless, as it is in the case of Down's syndrome, every child with the particular genetic marker develops the disorder and no child without the marker develops the disorder. And the researchers looking at genetic links, brain functioning, neurocognitive differences, ToM, or environmental toxins, know this, but the scope of the problem is so big that researchers must take a little piece at a time. Sorry I digressed.

What would be very very interesting to see is how the increase in Autism during the last 20 years compares to the increase in other disorders when awareness of the disorder reached mass levels. We know the awareness theory, but we can actually test such theory. Think for example mental retardation. 50 years ago if you were in a farm in the middle of Alabama (no insult intended to AL people) and you had a kid with MR or you developed mild bipolar disorder, it would be unlikely that the kid or you would not show up in any doctor's office for a diagnosis. Today, no matter how rural the conditions are, the kid would get a diagnosis. So the question is what is the impact of "massification" of a disorder? Is the change from pre-public awareness to post-public awareness so severe to explain these increases? I don't know, but I would love to see studies looking at similar effects in other conditions: MR, Alzheimer's disease, bipolar disorders, etc. I will do some research and consult some of my colleagues, but if you know of any such studies let me know. Cheers.

Anonymous said...

"Smug assumptions to the contrary are simply not based on evidence or sound reasoning."

Assumptions suggesting that environmental concerns explain away the increase are simply not based on evidence or sound reasoning. The increase CAN possibly be explained by environmental causes, certainly, but what the heck do you know of Alabama's environmental status? Nothing. I'm 100% sure that there are groups studying this increase in diagnoses and, in the process, are looking to every possible explanation, including environmental. But the answers aren't there yet.

As well, just because reports have come in that children with autism have higher amounts of mercury in their blood do not mean that autism is caused by mercury. It could mean that this widly misunderstood condition has additional effects on biochemistry, such as the ability to excrete certain toxins. Or that the nature of the studies (either for or against the theory) is flawed. I don't believe we know the answer to that question, but based on purely scientific evidence, I don't believe that autism is caused by mercury, though there is a chance that it contributes to SOME cases, or perhaps increases the severity in SOME cases.

It's irresponsible to suggest that anybody knows anything for certain about this disease. In my considerable research (and, yes, I realize you don't know me from Adam, but it should suffice to say I'm not your standard internet-enabled parent), I have come to one and only one conclusion so far: People who subscribe to any one theory with religious ferver are just seeking something tangible to blame for what is more likely to be an uncontrollable confluence of many circumstances that led to a diagnosis of autism.

You see, it's difficult for some (many, perhaps) people to accept that random events can conspire to cause autism in their kids. Even harder to think that it might be 100% genetic.

It's precisely because nobody knows the answers that this topic is so divisive. But that divisiveness serves no purpose. It's infuriating for me, as the father of a three year old boy with autism, to watch all this energy being spent on debate thinly disguised as "public service" when it could be spent on more useful awareness efforts, such as encouraging parents to seek all avenues of treatment available to them, or helping parents of so-called typical kids understand the differences between their children and ours, so that the interplay between the groups can be better enabled.

I, for one, am damn sick of the posturing.

Unknown said...

Dad of 3 year old boy with autism

If you are damn sick of posturing then stop posturing. Your sickness might subside substantially if you swallowed your own medicine.

If you bothered to read my comments on this site you would know that I do not take a position or a "posture" that autism is caused by vaccines. My point which you appeared to miss in your rage was that explaining the increase solely on the basis of changes in diagnostic criteria and social phenonomena umdoubtedly play a part in explaining some but not necessarily ALL of the dramatic increases such as are found in Alabama. There are no existing studies and no evidence to show that the ENTIRETY of the dramatic increases in autism in Alabama and elsewhere arise solely from such factors.

If you think I am wrong ... then prove me wrong. Provide the studies to the contrary. But please don't hide behind the geographical location in question. The world environment does not stop at the Alabama border.

Prove me wrong by all means. But please quit posturing ... hypocrisy doesn't look good on anyone.

Anonymous said...

Perhaps if you checked the actual rates, you would realize that even with the big "increase" Alabama still lags behind the rest of the US in identifying autistic students.

The last line of that article is the scary one:

Folsom said the budget forecast prompted the task force to look for ideas requiring little money.

Alabama has as many autistic students as it can afford. Apparantly they think they can't afford many.

Nestor L. Lopez-Duran PhD said...

Hi H, so putting aside the tone of some of these comments (I think some people have not read the rest of your blog, or they would realize you have a moderate, very sensible position on these delicate issues), I think the interesting point is that it is possible that the rapid increase in Alabama is the result of Alabama's attempts to catch up with the rest of the States in regards to services, etc. This is quite possible, and it would be interesting to see how this increase compares to other states that had significantly limited resources and have also gone through a transformation of their health care systems (thinking Mississippi, Louisiana, some of the northern plains states, etc). But I don't think your position was as extreme as some people took it. Most researchers I know agree that it is highly unlikely that the increase in rates is due solely to an increase in awareness, but we don't know this for sure yet.
Translating Autism

Anonymous said...

Well, that's it for me. I only recently started reading your blog, but I have read through your considerable archives. But if your response to me is indicative of how you handle someone disagreeing with you our pointing out your faults, I don't want any part of it.

Good luck to you and you son.

Unknown said...

To dad of 3 year old boy with autism

I deal with people according to how they present themselves on this forum. You got what you gave.

You wished my son well. For that I thank you. And I wish the same for your son.

- Dad of 12 year old boy with autism.

Anonymous said...