Re: NYT, No Autism Epidemic

June 11, 2007

Will a lurker from the CDC or the FDA, or some pharmaceutical company PLEASE tell us what number constitutes an epidemic?

If 1:150 is not an epidemic, what the F**k is?

Harry HofherrSee what's free at AOL.com.

June 11, 2007

Written by: PAUL SHATTUCK and MAUREEN DURKIN

>

> New York Time Editorial - no autism epidemic. One interesting

mention of

> looking at Environmental triggers though.

>

> http://www.nytimes.com/2007/06/11/opinion/11shattuck.html?

pagewanted=2

> <http://www.nytimes.com/2007/06/11/opinion/11shattuck.html?

pagewanted=2 & _r=1

> > & _r=1

>

> TODAY the special " vaccine court " at the United States Court of

Federal

> Claims in Washington will begin hearing Cedillo v. Secretary of

Health and

> Human Services, the first case of about 4,800 similar ones to

examine

> whether childhood vaccinations can cause autism. We have no wish to

comment

> on these legal issues. But having spent years researching the

prevalence of

> autism in American children, we are concerned that publicity

surrounding the

> case will only drag out debate about whether past trends indicate

we face an

> autism " epidemic. "

>

> The claims for or against an autism epidemic simply cannot be

proved given

> the evidence available. (Public attention to the issue was set off

primarily

> by a 1999 report by the State of California that found " a 273

percent

> increase in the number of persons with autism between 1987 and

1998. " ) In

> the end, arguing over what the old data mean just detracts from the

more

> pressing issues involved with scientific research and building

> cost-effective support systems for affected children, adults and

their

> families.

>

> The latest data from the Centers for Disease Control and Prevention

indicate

> that 1 in 150 8-year-old children are on the " autism spectrum. " This

> proportion is alarming if compared directly to estimates of the

frequency of

> autism before the 1990s, which were in the range of 1 per 2,000 to

5,000.

> But does this really mean we have a growing autism epidemic, or

have we just

> become better at counting autistic traits in the population that

have always

> been there at roughly the same level?

>

> What remains undisputable is that more and more children are being

labeled

> with autism. In 1943, when the child psychiatrist Leo Kanner

published the

> first case studies of autism as a medical condition, it was

characterized by

> very severe impairments in social interaction and language and

communicative

> abilities, combined with the presence of unusual repetitious

behaviors.

>

> As our understanding of the symptoms Kanner described has grown,

the notion

> of an autism spectrum, based on gradations of severity, has

evolved. Most of

> the more mildly affected children who are considered to be on the

spectrum

> today would never have qualified for an autism diagnosis using older

> criteria. This expansion of criteria makes it impossible to compare

apples

> to apples when looking at data on long-term trends, because what

counts as

> " autism " is simply quite different today.

>

> Another fact hinders our ability to accurately measure changes in

autism

> prevalence: while scientists have made improvements in the ability

to detect

> autism earlier, its causes are still not known and there are no

biological

> diagnostic tests. Diagnosis is made by observing behavior to see if

it

> corresponds with formal diagnostic criteria. Disagreements over

whether a

> child has autism are not uncommon, especially among those more

mildly

> affected.

>

> Advances in techniques for monitoring autism as a public health

problem have

> also led to statistical confusion. Whereas older studies used narrow

> definitions of autism and were generally based on counting the

number of

> patients in a clinic or hospital with diagnoses of autism, modern

methods

> use broader criteria and leave no stone unturned in the effort to

find every

> autistic child in a defined geographic area, including those not

previously

> given a diagnosis. This virtually guarantees that new estimates

will be

> higher than previous ones, even if the underlying prevalence of the

> condition has not changed.

>

> Also contributing to the rising identification of autism - and many

other

> conditions that are diagnosed in childhood like attention deficit

> hyperactivity disorder and bipolar disorder - was the growing

number of

> federally financed efforts to find and help preschool children with

> developmental disabilities in the 1980s and 1990s. More recently,

increased

> federal financing has been specifically aimed at raising awareness

of the

> early signs of autism and the importance of early identification.

It's

> hardly a surprise that looking harder to find children with

disabilities has

> resulted in more diagnoses.

>

> Clearly there are many alternative explanations for changing autism

> prevalence. This is what makes it such a difficult phenomenon to

> investigate. Some who feel that autism has reached epidemic

proportions cite

> enrollment trends in special education. In an effort to clarify

things, we

> collected and examined the special education enrollment data from

every

> state and for every classification category between 1984 and 2003.

We

> analyzed the numbers using several different statistical

approaches, and we

> arrived at similar conclusions regardless of which method we used.

>

> According to federal data, the number of children receiving special

> education services for autism has increased each year since 1991,

when

> Washington's guidelines first required schools to break out counts

of

> children on the spectrum. In the 1991-92 school year, 5,415

students ages 6

> to 21 in special education programs were identified as autistic. By

2005-06,

> this number had grown to 192,643, a 3,500 percent increase.

>

> Though large, this increase does not necessarily provide evidence

of an

> autism epidemic or an actual increase in the prevalence of autism.

Given

> that schools cannot respond to a federal mandate overnight, the

baseline

> count in 1991 was clearly an underestimate of how many children in

the

> nation truly had autism. This renders the resulting percent change

estimates

> over time utterly uninformative about changes in true prevalence.

(In fact,

> if the C.D.C.'s estimate that 1 out of 150 children are on the

spectrum is

> correct, the 2005 count still under-represents how many truly have

autism.)

>

> In addition, federal criteria for classifying children into the

autism

> special education category are not equivalent to those used for

medical

> diagnoses, and identification practices vary widely among school

districts.

> Before the 1990s, children with autism were tallied in other

categories,

> though no data exist to tell us exactly which ones.

>

> Urban planners know that " if you build a new road, people will

drive on it. "

> Likewise, in special education, if you create a new counting

category,

> people will use it. At the same time, older counting categories may

then be

> used less frequently as our ability to differentiate diagnoses

improves. And

> true enough, our study found that the growth in children classified

with

> autism was accompanied by a corresponding decrease in the number of

special

> education students with other designations.

>

> This is an example of " diagnostic substitution " - as information on

new

> autism classifications has gradually spread, the label " autistic "

has been

> used more commonly for children who previously would have been

labeled

> something else. Our analyses demonstrated that from 1994 to 2003,

in 44 of

> 50 states, the increase in autism was completely offset by a

decrease in the

> prevalence of children considered " cognitively disabled "

or " learning

> disabled. "

>

> What does this all mean? First, we should be wary of " epidemic "

claims and

> percentage increases based on administrative data. Second, we

should not be

> surprised if school counts of children with autism continue

increasing as

> they play catch-up to the number who truly have autism.

>

> We want to be very clear: our results do not mean we have nothing

to worry

> about. Scientific and clinical advances have improved our ability to

> identify autistic children and to differentiate their unique needs

from

> those of children with other types of developmental disabilities.

But

> schools and other social service systems are unable to keep pace

with these

> changes or give the children the help they need.

>

> Research to discover what causes autism, including possible

environmental

> triggers, must be a top priority. However, autism is not purely a

medical

> puzzle - as we invest in new ways of understanding autism, we have a

> corresponding responsibility to invest in the capacity of our

schools,

> medical centers and social workers to provide up-to-date treatment

for those

> with the condition and support services for their families. In the

end, we

> should not have to deliver a verdict on whether there is an

epidemic to

> fulfill these obligations.

>

June 11, 2007

Yea, it’s like…………………MAGIC!

From: EOHarm [mailto:EOHarm ] On Behalf Of trophyfish2

Sent: Monday, June 11, 2007 8:47

AM

EOHarm

Subject: Re: NYT,

" No Autism Epidemic "

How in the hell does better diagnosis occur in all 50

states, by tens

of thousands of doctors and related health care workers

simultaneously?

>

> New York

Time Editorial - no autism epidemic. One interesting

mention of

> looking at Environmental triggers though.

>

> http://www.nytimes.com/2007/06/11/opinion/11shattuck.html?

pagewanted=2

> <http://www.nytimes.com/2007/06/11/opinion/11shattuck.html?

pagewanted=2 & _r=1

> > & _r=1

>

> TODAY the special " vaccine court " at the United States Court of

Federal

> Claims in Washington

will begin hearing Cedillo v. Secretary of

Health and

> Human Services, the first case of about 4,800 similar ones to

examine

> whether childhood vaccinations can cause autism. We have no wish to

comment

> on these legal issues. But having spent years researching the

prevalence of

> autism in American children, we are concerned that publicity

surrounding the

> case will only drag out debate about whether past trends indicate

we face an

> autism " epidemic. "

>

> The claims for or against an autism epidemic simply cannot be

proved given

> the evidence available. (Public attention to the issue was set off

primarily

> by a 1999 report by the State of California

that found " a 273

percent

> increase in the number of persons with autism between 1987 and

1998. " ) In

> the end, arguing over what the old data mean just detracts from the

more

> pressing issues involved with scientific research and building

> cost-effective support systems for affected children, adults and

their

> families.

>

> The latest data from the Centers for Disease Control and Prevention

indicate

> that 1 in 150 8-year-old children are on the " autism spectrum. "

This

> proportion is alarming if compared directly to estimates of the

frequency of

> autism before the 1990s, which were in the range of 1 per 2,000 to

5,000.

> But does this really mean we have a growing autism epidemic, or

have we just

> become better at counting autistic traits in the population that

have always

> been there at roughly the same level?

>

> What remains undisputable is that more and more children are being

labeled

> with autism. In 1943, when the child psychiatrist Leo Kanner

published the

> first case studies of autism as a medical condition, it was

characterized by

> very severe impairments in social interaction and language and

communicative

> abilities, combined with the presence of unusual repetitious

behaviors.

>

> As our understanding of the symptoms Kanner described has grown,

the notion

> of an autism spectrum, based on gradations of severity, has

evolved. Most of

> the more mildly affected children who are considered to be on the

spectrum

> today would never have qualified for an autism diagnosis using older

> criteria. This expansion of criteria makes it impossible to compare

apples

> to apples when looking at data on long-term trends, because what

counts as

> " autism " is simply quite different today.

>

> Another fact hinders our ability to accurately measure changes in

autism

> prevalence: while scientists have made improvements in the ability

to detect

> autism earlier, its causes are still not known and there are no

biological

> diagnostic tests. Diagnosis is made by observing behavior to see if

it

> corresponds with formal diagnostic criteria. Disagreements over

whether a

> child has autism are not uncommon, especially among those more

mildly

> affected.

>

> Advances in techniques for monitoring autism as a public health

problem have

> also led to statistical confusion. Whereas older studies used narrow

> definitions of autism and were generally based on counting the

number of

> patients in a clinic or hospital with diagnoses of autism, modern

methods

> use broader criteria and leave no stone unturned in the effort to

find every

> autistic child in a defined geographic area, including those not

previously

> given a diagnosis. This virtually guarantees that new estimates

will be

> higher than previous ones, even if the underlying prevalence of the

> condition has not changed.

>

> Also contributing to the rising identification of autism - and many

other

> conditions that are diagnosed in childhood like attention deficit

> hyperactivity disorder and bipolar disorder - was the growing

number of

> federally financed efforts to find and help preschool children with

> developmental disabilities in the 1980s and 1990s. More recently,

increased

> federal financing has been specifically aimed at raising awareness

of the

> early signs of autism and the importance of early identification.

It's

> hardly a surprise that looking harder to find children with

disabilities has

> resulted in more diagnoses.

>

> Clearly there are many alternative explanations for changing autism

> prevalence. This is what makes it such a difficult phenomenon to

> investigate. Some who feel that autism has reached epidemic

proportions cite

> enrollment trends in special education. In an effort to clarify

things, we

> collected and examined the special education enrollment data from

every

> state and for every classification category between 1984 and 2003.

We

> analyzed the numbers using several different statistical

approaches, and we

> arrived at similar conclusions regardless of which method we used.

>

> According to federal data, the number of children receiving special

> education services for autism has increased each year since 1991,

when

> Washington's

guidelines first required schools to break out counts

of

> children on the spectrum. In the 1991-92 school year, 5,415

students ages 6

> to 21 in special education programs were identified as autistic. By

2005-06,

> this number had grown to 192,643, a 3,500 percent increase.

>

> Though large, this increase does not necessarily provide evidence

of an

> autism epidemic or an actual increase in the prevalence of autism.

Given

> that schools cannot respond to a federal mandate overnight, the

baseline

> count in 1991 was clearly an underestimate of how many children in

the

> nation truly had autism. This renders the resulting percent change

estimates

> over time utterly uninformative about changes in true prevalence.

(In fact,

> if the C.D.C.'s estimate that 1 out of 150 children are on the

spectrum is

> correct, the 2005 count still under-represents how many truly have

autism.)

>

> In addition, federal criteria for classifying children into the

autism

> special education category are not equivalent to those used for

medical

> diagnoses, and identification practices vary widely among school

districts.

> Before the 1990s, children with autism were tallied in other

categories,

> though no data exist to tell us exactly which ones.

>

> Urban planners know that " if you build a new road, people will

drive on it. "

> Likewise, in special education, if you create a new counting

category,

> people will use it. At the same time, older counting categories may

then be

> used less frequently as our ability to differentiate diagnoses

improves. And

> true enough, our study found that the growth in children classified

with

> autism was accompanied by a corresponding decrease in the number of

special

> education students with other designations.

>

> This is an example of " diagnostic substitution " - as information

on

new

> autism classifications has gradually spread, the label

" autistic "

has been

> used more commonly for children who previously would have been

labeled

> something else. Our analyses demonstrated that from 1994 to 2003,

in 44 of

> 50 states, the increase in autism was completely offset by a

decrease in the

> prevalence of children considered " cognitively disabled "

or " learning

> disabled. "

>

> What does this all mean? First, we should be wary of " epidemic "

claims and

> percentage increases based on administrative data. Second, we

should not be

> surprised if school counts of children with autism continue

increasing as

> they play catch-up to the number who truly have autism.

>

> We want to be very clear: our results do not mean we have nothing

to worry

> about. Scientific and clinical advances have improved our ability to

> identify autistic children and to differentiate their unique needs

from

> those of children with other types of developmental disabilities.

But

> schools and other social service systems are unable to keep pace

with these

> changes or give the children the help they need.

>

> Research to discover what causes autism, including possible

environmental

> triggers, must be a top priority. However, autism is not purely a

medical

> puzzle - as we invest in new ways of understanding autism, we have a

> corresponding responsibility to invest in the capacity of our

schools,

> medical centers and social workers to provide up-to-date treatment

for those

> with the condition and support services for their families. In the

end, we

> should not have to deliver a verdict on whether there is an

epidemic to

> fulfill these obligations.

>

June 11, 2007

The NYTimes has been fundamentally dishonest about this issue.

NYT, "No Autism Epidemic"

New York Time Editorial – no autism epidemic. One interesting mention of looking at Environmental triggers though.

http://www.nytimes.com/2007/06/11/opinion/11shattuck.html?pagewanted=2 & _r=1

TODAY the special “vaccine court” at the United States Court of Federal Claims in Washington will begin hearing Cedillo v. Secretary of Health and Human Services, the first case of about 4,800 similar ones to examine whether childhood vaccinations can cause autism. We have no wish to comment on these legal issues. But having spent years researching the prevalence of autism in American children, we are concerned that publicity surrounding the case will only drag out debate about whether past trends indicate we face an autism “epidemic.”

The claims for or against an autism epidemic simply cannot be proved given the evidence available. (Public attention to the issue was set off primarily by a 1999 report by the State of California that found “a 273 percent increase in the number of persons with autism between 1987 and 1998.”) In the end, arguing over what the old data mean just detracts from the more pressing issues involved with scientific research and building cost-effective support systems for affected children, adults and their families

June 11, 2007

Think what a pariah these people in denial will become when this is all

hindsight.

" Mt. Vesuvius is a volcano??? No way! " --Former Pompeii resident

> >

> > New York Time Editorial - no autism epidemic. One interesting

> mention of

> > looking at Environmental triggers though.

> >

> > http://www.nytimes.com/2007/06/11/opinion/11shattuck.html?

> pagewanted=2

> > <http://www.nytimes.com/2007/06/11/opinion/11shattuck.html?

> pagewanted=2 & _r=1

> > > & _r=1

> >

> > TODAY the special " vaccine court " at the United States Court of

> Federal

> > Claims in Washington will begin hearing Cedillo v. Secretary of

> Health and

> > Human Services, the first case of about 4,800 similar ones to

> examine

> > whether childhood vaccinations can cause autism. We have no wish to

> comment

> > on these legal issues. But having spent years researching the

> prevalence of

> > autism in American children, we are concerned that publicity

> surrounding the

> > case will only drag out debate about whether past trends indicate

> we face an

> > autism " epidemic. "

> >

> > The claims for or against an autism epidemic simply cannot be

> proved given

> > the evidence available. (Public attention to the issue was set off

> primarily

> > by a 1999 report by the State of California that found " a 273

> percent

> > increase in the number of persons with autism between 1987 and

> 1998. " ) In

> > the end, arguing over what the old data mean just detracts from the

> more

> > pressing issues involved with scientific research and building

> > cost-effective support systems for affected children, adults and

> their

> > families.

> >

> > The latest data from the Centers for Disease Control and Prevention

> indicate

> > that 1 in 150 8-year-old children are on the " autism spectrum. " This

> > proportion is alarming if compared directly to estimates of the

> frequency of

> > autism before the 1990s, which were in the range of 1 per 2,000 to

> 5,000.

> > But does this really mean we have a growing autism epidemic, or

> have we just

> > become better at counting autistic traits in the population that

> have always

> > been there at roughly the same level?

> >

> > What remains undisputable is that more and more children are being

> labeled

> > with autism. In 1943, when the child psychiatrist Leo Kanner

> published the

> > first case studies of autism as a medical condition, it was

> characterized by

> > very severe impairments in social interaction and language and

> communicative

> > abilities, combined with the presence of unusual repetitious

> behaviors.

> >

> > As our understanding of the symptoms Kanner described has grown,

> the notion

> > of an autism spectrum, based on gradations of severity, has

> evolved. Most of

> > the more mildly affected children who are considered to be on the

> spectrum

> > today would never have qualified for an autism diagnosis using older

> > criteria. This expansion of criteria makes it impossible to compare

> apples

> > to apples when looking at data on long-term trends, because what

> counts as

> > " autism " is simply quite different today.

> >

> > Another fact hinders our ability to accurately measure changes in

> autism

> > prevalence: while scientists have made improvements in the ability

> to detect

> > autism earlier, its causes are still not known and there are no

> biological

> > diagnostic tests. Diagnosis is made by observing behavior to see if

> it

> > corresponds with formal diagnostic criteria. Disagreements over

> whether a

> > child has autism are not uncommon, especially among those more

> mildly

> > affected.

> >

> > Advances in techniques for monitoring autism as a public health

> problem have

> > also led to statistical confusion. Whereas older studies used narrow

> > definitions of autism and were generally based on counting the

> number of

> > patients in a clinic or hospital with diagnoses of autism, modern

> methods

> > use broader criteria and leave no stone unturned in the effort to

> find every

> > autistic child in a defined geographic area, including those not

> previously

> > given a diagnosis. This virtually guarantees that new estimates

> will be

> > higher than previous ones, even if the underlying prevalence of the

> > condition has not changed.

> >

> > Also contributing to the rising identification of autism - and many

> other

> > conditions that are diagnosed in childhood like attention deficit

> > hyperactivity disorder and bipolar disorder - was the growing

> number of

> > federally financed efforts to find and help preschool children with

> > developmental disabilities in the 1980s and 1990s. More recently,

> increased

> > federal financing has been specifically aimed at raising awareness

> of the

> > early signs of autism and the importance of early identification.

> It's

> > hardly a surprise that looking harder to find children with

> disabilities has

> > resulted in more diagnoses.

> >

> > Clearly there are many alternative explanations for changing autism

> > prevalence. This is what makes it such a difficult phenomenon to

> > investigate. Some who feel that autism has reached epidemic

> proportions cite

> > enrollment trends in special education. In an effort to clarify

> things, we

> > collected and examined the special education enrollment data from

> every

> > state and for every classification category between 1984 and 2003.

> We

> > analyzed the numbers using several different statistical

> approaches, and we

> > arrived at similar conclusions regardless of which method we used.

> >

> > According to federal data, the number of children receiving special

> > education services for autism has increased each year since 1991,

> when

> > Washington's guidelines first required schools to break out counts

> of

> > children on the spectrum. In the 1991-92 school year, 5,415

> students ages 6

> > to 21 in special education programs were identified as autistic. By

> 2005-06,

> > this number had grown to 192,643, a 3,500 percent increase.

> >

> > Though large, this increase does not necessarily provide evidence

> of an

> > autism epidemic or an actual increase in the prevalence of autism.

> Given

> > that schools cannot respond to a federal mandate overnight, the

> baseline

> > count in 1991 was clearly an underestimate of how many children in

> the

> > nation truly had autism. This renders the resulting percent change

> estimates

> > over time utterly uninformative about changes in true prevalence.

> (In fact,

> > if the C.D.C.'s estimate that 1 out of 150 children are on the

> spectrum is

> > correct, the 2005 count still under-represents how many truly have

> autism.)

> >

> > In addition, federal criteria for classifying children into the

> autism

> > special education category are not equivalent to those used for

> medical

> > diagnoses, and identification practices vary widely among school

> districts.

> > Before the 1990s, children with autism were tallied in other

> categories,

> > though no data exist to tell us exactly which ones.

> >

> > Urban planners know that " if you build a new road, people will

> drive on it. "

> > Likewise, in special education, if you create a new counting

> category,

> > people will use it. At the same time, older counting categories may

> then be

> > used less frequently as our ability to differentiate diagnoses

> improves. And

> > true enough, our study found that the growth in children classified

> with

> > autism was accompanied by a corresponding decrease in the number of

> special

> > education students with other designations.

> >

> > This is an example of " diagnostic substitution " - as information on

> new

> > autism classifications has gradually spread, the label " autistic "

> has been

> > used more commonly for children who previously would have been

> labeled

> > something else. Our analyses demonstrated that from 1994 to 2003,

> in 44 of

> > 50 states, the increase in autism was completely offset by a

> decrease in the

> > prevalence of children considered " cognitively disabled "

> or " learning

> > disabled. "

> >

> > What does this all mean? First, we should be wary of " epidemic "

> claims and

> > percentage increases based on administrative data. Second, we

> should not be

> > surprised if school counts of children with autism continue

> increasing as

> > they play catch-up to the number who truly have autism.

> >

> > We want to be very clear: our results do not mean we have nothing

> to worry

> > about. Scientific and clinical advances have improved our ability to

> > identify autistic children and to differentiate their unique needs

> from

> > those of children with other types of developmental disabilities.

> But

> > schools and other social service systems are unable to keep pace

> with these

> > changes or give the children the help they need.

> >

> > Research to discover what causes autism, including possible

> environmental

> > triggers, must be a top priority. However, autism is not purely a

> medical

> > puzzle - as we invest in new ways of understanding autism, we have a

> > corresponding responsibility to invest in the capacity of our

> schools,

> > medical centers and social workers to provide up-to-date treatment

> for those

> > with the condition and support services for their families. In the

> end, we

> > should not have to deliver a verdict on whether there is an

> epidemic to

> > fulfill these obligations.

> >

>

June 11, 2007

Mass hypnosis???

> >

> Recent Activity

> a.. 36New Members

> b.. 3New Files

> Visit Your Group

>

June 11, 2007

No, a deeply-ingrained value system and business necessity at the

Times to support elite institutions, and their pharmaceutical

advertisers, and a concommitant contempt for any idea, movement of

trend that is seen as not under the control of elite institutions.

> > >

> > Recent Activity

> > a.. 36New Members

> > b.. 3New Files

> > Visit Your Group

> >

June 11, 2007

When they say in 44 of 50 states, the increase in autism is offset by

decreases in MR and LD, it really DOES sound like a shift in

labeling. Is that really true?

R

> >

> > New York Time Editorial - no autism epidemic. One interesting

> mention of

> > looking at Environmental triggers though.

> >

> > http://www.nytimes.com/2007/06/11/opinion/11shattuck.html?

> pagewanted=2

> > <http://www.nytimes.com/2007/06/11/opinion/11shattuck.html?

> pagewanted=2 & _r=1

> > > & _r=1

> >

> > TODAY the special " vaccine court " at the United States Court of

> Federal

> > Claims in Washington will begin hearing Cedillo v. Secretary of

> Health and

> > Human Services, the first case of about 4,800 similar ones to

> examine

> > whether childhood vaccinations can cause autism. We have no wish

to

> comment

> > on these legal issues. But having spent years researching the

> prevalence of

> > autism in American children, we are concerned that publicity

> surrounding the

> > case will only drag out debate about whether past trends indicate

> we face an

> > autism " epidemic. "

> >

> > The claims for or against an autism epidemic simply cannot be

> proved given

> > the evidence available. (Public attention to the issue was set

off

> primarily

> > by a 1999 report by the State of California that found " a 273

> percent

> > increase in the number of persons with autism between 1987 and

> 1998. " ) In

> > the end, arguing over what the old data mean just detracts from

the

> more

> > pressing issues involved with scientific research and building

> > cost-effective support systems for affected children, adults and

> their

> > families.

> >

> > The latest data from the Centers for Disease Control and

Prevention

> indicate

> > that 1 in 150 8-year-old children are on the " autism spectrum. "

This

> > proportion is alarming if compared directly to estimates of the

> frequency of

> > autism before the 1990s, which were in the range of 1 per 2,000

to

> 5,000.

> > But does this really mean we have a growing autism epidemic, or

> have we just

> > become better at counting autistic traits in the population that

> have always

> > been there at roughly the same level?

> >

> > What remains undisputable is that more and more children are

being

> labeled

> > with autism. In 1943, when the child psychiatrist Leo Kanner

> published the

> > first case studies of autism as a medical condition, it was

> characterized by

> > very severe impairments in social interaction and language and

> communicative

> > abilities, combined with the presence of unusual repetitious

> behaviors.

> >

> > As our understanding of the symptoms Kanner described has grown,

> the notion

> > of an autism spectrum, based on gradations of severity, has

> evolved. Most of

> > the more mildly affected children who are considered to be on the

> spectrum

> > today would never have qualified for an autism diagnosis using

older

> > criteria. This expansion of criteria makes it impossible to

compare

> apples

> > to apples when looking at data on long-term trends, because what

> counts as

> > " autism " is simply quite different today.

> >

> > Another fact hinders our ability to accurately measure changes in

> autism

> > prevalence: while scientists have made improvements in the

ability

> to detect

> > autism earlier, its causes are still not known and there are no

> biological

> > diagnostic tests. Diagnosis is made by observing behavior to see

if

> it

> > corresponds with formal diagnostic criteria. Disagreements over

> whether a

> > child has autism are not uncommon, especially among those more

> mildly

> > affected.

> >

> > Advances in techniques for monitoring autism as a public health

> problem have

> > also led to statistical confusion. Whereas older studies used

narrow

> > definitions of autism and were generally based on counting the

> number of

> > patients in a clinic or hospital with diagnoses of autism, modern

> methods

> > use broader criteria and leave no stone unturned in the effort to

> find every

> > autistic child in a defined geographic area, including those not

> previously

> > given a diagnosis. This virtually guarantees that new estimates

> will be

> > higher than previous ones, even if the underlying prevalence of

the

> > condition has not changed.

> >

> > Also contributing to the rising identification of autism - and

many

> other

> > conditions that are diagnosed in childhood like attention deficit

> > hyperactivity disorder and bipolar disorder - was the growing

> number of

> > federally financed efforts to find and help preschool children

with

> > developmental disabilities in the 1980s and 1990s. More recently,

> increased

> > federal financing has been specifically aimed at raising

awareness

> of the

> > early signs of autism and the importance of early identification.

> It's

> > hardly a surprise that looking harder to find children with

> disabilities has

> > resulted in more diagnoses.

> >

> > Clearly there are many alternative explanations for changing

autism

> > prevalence. This is what makes it such a difficult phenomenon to

> > investigate. Some who feel that autism has reached epidemic

> proportions cite

> > enrollment trends in special education. In an effort to clarify

> things, we

> > collected and examined the special education enrollment data from

> every

> > state and for every classification category between 1984 and

2003.

> We

> > analyzed the numbers using several different statistical

> approaches, and we

> > arrived at similar conclusions regardless of which method we used.

> >

> > According to federal data, the number of children receiving

special

> > education services for autism has increased each year since 1991,

> when

> > Washington's guidelines first required schools to break out

counts

> of

> > children on the spectrum. In the 1991-92 school year, 5,415

> students ages 6

> > to 21 in special education programs were identified as autistic.

By

> 2005-06,

> > this number had grown to 192,643, a 3,500 percent increase.

> >

> > Though large, this increase does not necessarily provide evidence

> of an

> > autism epidemic or an actual increase in the prevalence of

autism.

> Given

> > that schools cannot respond to a federal mandate overnight, the

> baseline

> > count in 1991 was clearly an underestimate of how many children

in

> the

> > nation truly had autism. This renders the resulting percent

change

> estimates

> > over time utterly uninformative about changes in true prevalence.

> (In fact,

> > if the C.D.C.'s estimate that 1 out of 150 children are on the

> spectrum is

> > correct, the 2005 count still under-represents how many truly

have

> autism.)

> >

> > In addition, federal criteria for classifying children into the

> autism

> > special education category are not equivalent to those used for

> medical

> > diagnoses, and identification practices vary widely among school

> districts.

> > Before the 1990s, children with autism were tallied in other

> categories,

> > though no data exist to tell us exactly which ones.

> >

> > Urban planners know that " if you build a new road, people will

> drive on it. "

> > Likewise, in special education, if you create a new counting

> category,

> > people will use it. At the same time, older counting categories

may

> then be

> > used less frequently as our ability to differentiate diagnoses

> improves. And

> > true enough, our study found that the growth in children

classified

> with

> > autism was accompanied by a corresponding decrease in the number

of

> special

> > education students with other designations.

> >

> > This is an example of " diagnostic substitution " - as information

on

> new

> > autism classifications has gradually spread, the label " autistic "

> has been

> > used more commonly for children who previously would have been

> labeled

> > something else. Our analyses demonstrated that from 1994 to 2003,

> in 44 of

> > 50 states, the increase in autism was completely offset by a

> decrease in the

> > prevalence of children considered " cognitively disabled "

> or " learning

> > disabled. "

> >

> > What does this all mean? First, we should be wary of " epidemic "

> claims and

> > percentage increases based on administrative data. Second, we

> should not be

> > surprised if school counts of children with autism continue

> increasing as

> > they play catch-up to the number who truly have autism.

> >

> > We want to be very clear: our results do not mean we have nothing

> to worry

> > about. Scientific and clinical advances have improved our ability

to

> > identify autistic children and to differentiate their unique

needs

> from

> > those of children with other types of developmental disabilities.

> But

> > schools and other social service systems are unable to keep pace

> with these

> > changes or give the children the help they need.

> >

> > Research to discover what causes autism, including possible

> environmental

> > triggers, must be a top priority. However, autism is not purely a

> medical

> > puzzle - as we invest in new ways of understanding autism, we

have a

> > corresponding responsibility to invest in the capacity of our

> schools,

> > medical centers and social workers to provide up-to-date

treatment

> for those

> > with the condition and support services for their families. In

the

> end, we

> > should not have to deliver a verdict on whether there is an

> epidemic to

> > fulfill these obligations.

> >

>

June 11, 2007

This is a really interesting article. At the same time that they are

saying that the IDEA data is inappropriate for use as a substitute

for real epidemiology they are using that same data to try and say

there is no increase in autism incidence.

It seem bizarre to me that we have business professors at COrnell,

and csocial anthropologists and journalist at the Times (and most of

th journalists I have ever known, and I used to be a reporter, are

functionally innumerate) all doing autism epidemiology.

The fact that they are doing this is good. It shows that the

extremely powerful institutions that the NYT serves are starting to

get worried about keeping a lid on the obvious epidemic that is

going on. Second they talk about the need for environnmental

research. This is big. This means the powerful now recognize that we

are wasting our time on genetics. Because you can be sure the Times

is not running this article without the blessing of the CDC.

The timing was also obviously selected to coincide with the

beginning of the Omnibus hearings.

> > >

> > > New York Time Editorial - no autism epidemic. One interesting

> > mention of

> > > looking at Environmental triggers though.

> > >

> > > http://www.nytimes.com/2007/06/11/opinion/11shattuck.html?

> > pagewanted=2

> > > <http://www.nytimes.com/2007/06/11/opinion/11shattuck.html?

> > pagewanted=2 & _r=1

> > > > & _r=1

> > >

> > > TODAY the special " vaccine court " at the United States Court

of

> > Federal

> > > Claims in Washington will begin hearing Cedillo v. Secretary

of

> > Health and

> > > Human Services, the first case of about 4,800 similar ones to

> > examine

> > > whether childhood vaccinations can cause autism. We have no

wish

> to

> > comment

> > > on these legal issues. But having spent years researching the

> > prevalence of

> > > autism in American children, we are concerned that publicity

> > surrounding the

> > > case will only drag out debate about whether past trends

indicate

> > we face an

> > > autism " epidemic. "

> > >

> > > The claims for or against an autism epidemic simply cannot be

> > proved given

> > > the evidence available. (Public attention to the issue was set

> off

> > primarily

> > > by a 1999 report by the State of California that found " a 273

> > percent

> > > increase in the number of persons with autism between 1987 and

> > 1998. " ) In

> > > the end, arguing over what the old data mean just detracts

from

> the

> > more

> > > pressing issues involved with scientific research and building

> > > cost-effective support systems for affected children, adults

and

> > their

> > > families.

> > >

> > > The latest data from the Centers for Disease Control and

> Prevention

> > indicate

> > > that 1 in 150 8-year-old children are on the " autism

spectrum. "

> This

> > > proportion is alarming if compared directly to estimates of

the

> > frequency of

> > > autism before the 1990s, which were in the range of 1 per

2,000

> to

> > 5,000.

> > > But does this really mean we have a growing autism epidemic,

or

> > have we just

> > > become better at counting autistic traits in the population

that

> > have always

> > > been there at roughly the same level?

> > >

> > > What remains undisputable is that more and more children are

> being

> > labeled

> > > with autism. In 1943, when the child psychiatrist Leo Kanner

> > published the

> > > first case studies of autism as a medical condition, it was

> > characterized by

> > > very severe impairments in social interaction and language and

> > communicative

> > > abilities, combined with the presence of unusual repetitious

> > behaviors.

> > >

> > > As our understanding of the symptoms Kanner described has

grown,

> > the notion

> > > of an autism spectrum, based on gradations of severity, has

> > evolved. Most of

> > > the more mildly affected children who are considered to be on

the

> > spectrum

> > > today would never have qualified for an autism diagnosis using

> older

> > > criteria. This expansion of criteria makes it impossible to

> compare

> > apples

> > > to apples when looking at data on long-term trends, because

what

> > counts as

> > > " autism " is simply quite different today.

> > >

> > > Another fact hinders our ability to accurately measure changes

in

> > autism

> > > prevalence: while scientists have made improvements in the

> ability

> > to detect

> > > autism earlier, its causes are still not known and there are

no

> > biological

> > > diagnostic tests. Diagnosis is made by observing behavior to

see

> if

> > it

> > > corresponds with formal diagnostic criteria. Disagreements

over

> > whether a

> > > child has autism are not uncommon, especially among those more

> > mildly

> > > affected.

> > >

> > > Advances in techniques for monitoring autism as a public

health

> > problem have

> > > also led to statistical confusion. Whereas older studies used

> narrow

> > > definitions of autism and were generally based on counting the

> > number of

> > > patients in a clinic or hospital with diagnoses of autism,

modern

> > methods

> > > use broader criteria and leave no stone unturned in the effort

to

> > find every

> > > autistic child in a defined geographic area, including those

not

> > previously

> > > given a diagnosis. This virtually guarantees that new

estimates

> > will be

> > > higher than previous ones, even if the underlying prevalence

of

> the

> > > condition has not changed.

> > >

> > > Also contributing to the rising identification of autism - and

> many

> > other

> > > conditions that are diagnosed in childhood like attention

deficit

> > > hyperactivity disorder and bipolar disorder - was the growing

> > number of

> > > federally financed efforts to find and help preschool children

> with

> > > developmental disabilities in the 1980s and 1990s. More

recently,

> > increased

> > > federal financing has been specifically aimed at raising

> awareness

> > of the

> > > early signs of autism and the importance of early

identification.

> > It's

> > > hardly a surprise that looking harder to find children with

> > disabilities has

> > > resulted in more diagnoses.

> > >

> > > Clearly there are many alternative explanations for changing

> autism

> > > prevalence. This is what makes it such a difficult phenomenon

to

> > > investigate. Some who feel that autism has reached epidemic

> > proportions cite

> > > enrollment trends in special education. In an effort to

clarify

> > things, we

> > > collected and examined the special education enrollment data

from

> > every

> > > state and for every classification category between 1984 and

> 2003.

> > We

> > > analyzed the numbers using several different statistical

> > approaches, and we

> > > arrived at similar conclusions regardless of which method we

used.

> > >

> > > According to federal data, the number of children receiving

> special

> > > education services for autism has increased each year since

1991,

> > when

> > > Washington's guidelines first required schools to break out

> counts

> > of

> > > children on the spectrum. In the 1991-92 school year, 5,415

> > students ages 6

> > > to 21 in special education programs were identified as

autistic.

> By

> > 2005-06,

> > > this number had grown to 192,643, a 3,500 percent increase.

> > >

> > > Though large, this increase does not necessarily provide

evidence

> > of an

> > > autism epidemic or an actual increase in the prevalence of

> autism.

> > Given

> > > that schools cannot respond to a federal mandate overnight,

the

> > baseline

> > > count in 1991 was clearly an underestimate of how many

children

> in

> > the

> > > nation truly had autism. This renders the resulting percent

> change

> > estimates

> > > over time utterly uninformative about changes in true

prevalence.

> > (In fact,

> > > if the C.D.C.'s estimate that 1 out of 150 children are on the

> > spectrum is

> > > correct, the 2005 count still under-represents how many truly

> have

> > autism.)

> > >

> > > In addition, federal criteria for classifying children into

the

> > autism

> > > special education category are not equivalent to those used

for

> > medical

> > > diagnoses, and identification practices vary widely among

school

> > districts.

> > > Before the 1990s, children with autism were tallied in other

> > categories,

> > > though no data exist to tell us exactly which ones.

> > >

> > > Urban planners know that " if you build a new road, people will

> > drive on it. "

> > > Likewise, in special education, if you create a new counting

> > category,

> > > people will use it. At the same time, older counting

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