autism rate criteria -- Several factors explain explosive growth in the diagnosis of autism

[Guest guest]

Common lore is that Calif rates for autism reflect DSM-IV criteria. If

that's true, then Calif isn't including PDD, ODD, etc, when determining

the rate of autism in Calif. Reporters like Mike Stobbe seem to enjoy

blurring the boundaries between autism and other disorders which (by

DSM-IV criteria) aren't autism. Has anyone evaluated autism

rate-criteria methodologies for recent studies? If so, what's the best

(recent) presentation of those methodologies? For instance, is the CDC's

1 in 150 notion based upon DSM-IV autism or is the 1 in 150 based upon

the broader category " ASDs " ? Similarly for other rate pronouncements

(eg, NJ, Calif).

- - - -

Dec 16, 2007

Several factors explain explosive growth in the diagnosis of autism

By MIKE STOBBE, The Associated Press

http://www.nashuatelegraph.com/apps/pbcs.dll/article?AID=/20071216/HEALTH/312160\

003

ATLANTA -- A few decades ago, people probably would have said kids like

Massey and Eddie Scheuplein were just odd. Or difficult.

Both boys are bright. But , 11, is hyper and prone to angry

outbursts, sometimes trying to strangle another kid in his class who

annoys him. Eddie, 7, has a strange habit of sticking his shirt in his

mouth and sucking on it.

Both were diagnosed with a form of autism. And it's partly because of

children like them that autism appears to be skyrocketing: In the latest

estimate, as many as one in 150 children have some form of this

disorder. Groups advocating more research money call autism " the

fastest-growing developmental disability in the United States. "

Indeed, doctors are concerned there are even more cases out there,

unrecognized: The American Academy of Pediatrics this fall stressed the

importance of screening every kid -- twice -- for autism by age 2.

But many experts believe these unsociable behaviors were just about as

common 30 or 40 years ago. The recent explosion of cases appears to be

mostly caused by a surge in special education services for autistic

children, and by a corresponding shift in what doctors call autism.

Autism has always been diagnosed by making judgments about a child's

behavior; there are no blood or biologic tests. For decades, the

diagnosis was given only to kids with severe language and social

impairments and unusual, repetitious behaviors.

Many children with severe autism hit themselves or others, don't speak

and don't make eye contact.

Blake Dees, a 19-year-old from Suwanee, Ga., falls into that group. For

the past eight years, he has been in a day program with intense

services, but he still doesn't talk, he's not toilet-trained and he has

a history of trying to eat anything -- even broken glass.

But he's not a typical case.

In the 1990s, the autism umbrella expanded, and autism is now shorthand

for a group of milder, related conditions, known as " autism spectrum

disorders. "

The spectrum includes Asperger's syndrome and something called PDD-NOS

(for Pervasive Developmental Disorder-Not Otherwise Specified). Some

support groups report more than half of their families fall into these

categories, but there is no commonly accepted scientific breakdown.

Gradually, there have been changes in parents' own perception of autism,

the autism services schools provide and the care that insurers pay for,

experts say.

Eddie, of Buford, Ga., was initially diagnosed with obsessive-compulsive

disorder, attention deficit hyperactivity disorder and other conditions.

But the services he got in school were not very helpful.

His mother, , said a diagnosis of autism brought occupational

therapy and other, better services.

" I do have to admit I almost like the idea of having the autistic label,

at least over the other labels, because there's more help out there for

you, " said Scheuplein.

" The truth is there's a powerful incentive for physicians and schools to

classify children in a way that gets services, " said Dr. Edwin Trevathan

of the U.S. Centers for Disease Control and Prevention.

Many with Asperger's and PDD-NOS succeed in school and do not -- at

first glance -- have much in common with children like Blake Dees.

At a recent gathering of families with Asperger's children in the

Atlanta area, parents told almost comical stories about kids who

frequently pick their noses, douse food in ketchup or wear the same

shirt day after day.

Such a frank, humorous exchange was once a rarity. Doctors for many

years believed in the " refrigerator mom " theory, which held that autism

was the result of being raised by a cold, unloving mother. The theory

became discredited, but was difficult to dislodge from the popular

conscience.

Even in the early 1980s, some parents were more comfortable with a

diagnosis of mental retardation than autism, said Trevathan, director of

the CDC's National Center on Birth Defects and Developmental Disabilities.

Today, parents are more likely to cringe at a diagnosis of mental

retardation, which is sometimes equated to a feeble-mindedness and may

obscure a child's potential.

And increasingly, professionals frown at the term: The special education

journal Mental Retardation this year changed its name to Intellectual &

Developmental Disabilities.

The editor said that " mentally retarded " is becoming passe and

demeaning, much like the terms idiot, imbecile and moron -- once used by

doctors to describe varying degrees of mental retardation.

In contrast, autism has become culturally acceptable -- and a ticket to

a larger range of school services and accommodations.

In 1990, Congress added the word " autism " as a separate disability

category to a federal law that guarantees special education services,

and Education Department regulations have included a separate definition

of autism since 1992.

Before that, children with autism were counted under other disabling

conditions, such as mental retardation, said Jim Bradshaw, an education

department spokesman.

The Social Security Administration also broadened its definition of

disability to include spectrum disorders, like Asperger's.

Something else changed: The development of new stimulants and other

medicines may have encouraged doctors to make diagnoses with the idea of

treating them with these drugs.

Perception of the size of the problem changed, too.

Fourteen years ago, only 1 in 10,000 children were diagnosed with it.

Prevalence estimates gradually rose to the current government estimate

of one in 150.

That increase has been mirrored in school districts. Gwinnett County

Public Schools -- Georgia's largest school system -- had eight

classrooms for teaching autistic youngsters 13 years ago; today there

are 180.

Some researchers suggest that as autism spectrum diagnoses have gone up,

diagnoses of mild mental retardation have fallen.

U.S. Department of Education data show that the number of students with

autism rose steadily, from about 42,500 in 1997 to nearly 225,000 in

2006. Meanwhile, the number of students counted as mentally retarded

declined from about 603,000 to about 523,000.

CDC scientists believe education numbers are misleading, because they

reflect only how kids are categorized for services. They say there's no

clear evidence doctors are substituting one diagnosis for the other.

Some parents believe environmental factors -- ranging from a

preservative in vaccines to contaminants in food or water -- may be

important contributors. (Since 2001, the preservative thimerosal has

been removed from shots recommended for young children, except for some

flu shots.)

Dr. Goldstein, scientific adviser to the national advocacy group

Autism Speaks, said the explanation for the rising autism prevalence is

probably complex. Labeling and diagnosing probably play a role, as do

genetics, but he believes the increase surpasses those two explanations.

" I'm seeing more children with autism than I ever would have expected to

see, " said Goldstein, who is chief executive of the Kennedy Krieger

Institute, a treatment center for pediatric developmental disabilities

in Baltimore.

Autism Speaks budgets more than $4 million each year to research the

causes of autism, and about 90 percent of that has gone to genetics

research. But organization officials recently have been talking about

changing that mix, and spending as much as 50 percent of that money on

potential environmental triggers, Goldstein said.

Whether it's because of genes or the environment (or both), autism has

hit the Massey family hard. Chuck and Massey, of Dacula, Ga., have

three sons with Asperger's.

The youngest, , was first diagnosed after he was slow to develop

speaking ability. His brothers -- Trevor, 14, and , 16 -- had

learning and behavior problems and were later diagnosed with Asperger's,

too.

All got special education services and were treated with medications.

has improved, or matured, or both, and is now a social kid in

mainstream classes at a Gwinnett County high school. Trevor seems to be

making the same transition, his mother said.

is the most extreme. He still has uncontrollable tantrums and must

attend an Asperger's-only sixth-grade classroom that teaches social

skills along with traditional subjects.

In a recent interview at the family's home, acknowledged he still

has anger control issues. One of the three other students in his class

is particularly irritating. said the way he reacts is by " grabbing

his throat. "

But on this night, was calm. He described himself as happy, and

paced the room telling jokes, like a nervous stand-up comedian. ( " Why

didn't the skeleton go to the party? He didn't have the guts, " he said,

eyes fixed on his audience.)

Having three Asperger's boys under one roof has at times been very

intense, Massey said, noting a replaced dining room window.

acknowledged it's been educational living in a house full of

Asperger's kids. Asked to name something he's learned from his brothers,

he replied, " Swears. "

© 2007, Telegraph Publishing Company, Nashua, New Hampshire

The material in this post is distributed without

profit to those who have expressed a prior interest

in receiving the included information for research

and educational purposes.For more information go to:

http://www4.law.cornell.edu/uscode/17/107.html

http://oregon.uoregon.edu/~csundt/documents.htm

If you wish to use copyrighted material from this

email for purposes that go beyond 'fair use', you

must obtain permission from the copyright owner*.*

[Guest guest]

PDD is under the DMS IV criteria

Recovering from Autism is a marathon

NOT a sprint, but FULLY possible!

Read more about it on my Blogs at

http://www.myspace.com/christelking

autism rate criteria -- Several factors explain

explosive growth in the diagnosis of autism

Common lore is that Calif rates for autism reflect DSM-IV criteria. If

that's true, then Calif isn't including PDD, ODD, etc, when determining

the rate of autism in Calif. Reporters like Mike Stobbe seem to enjoy

blurring the boundaries between autism and other disorders which (by

DSM-IV criteria) aren't autism. Has anyone evaluated autism

rate-criteria methodologies for recent studies? If so, what's the best

(recent) presentation of those methodologies? For instance, is the CDC's

1 in 150 notion based upon DSM-IV autism or is the 1 in 150 based upon

the broader category " ASDs " ? Similarly for other rate pronouncements

(eg, NJ, Calif).

- - - -

Dec 16, 2007

Several factors explain explosive growth in the diagnosis of autism

By MIKE STOBBE, The Associated Press

http://www.nashuatelegraph.com/apps/pbcs.dll/article?AID=/20071216/HEALTH/312160\

003

ATLANTA -- A few decades ago, people probably would have said kids like

Massey and Eddie Scheuplein were just odd. Or difficult.

Both boys are bright. But , 11, is hyper and prone to angry

outbursts, sometimes trying to strangle another kid in his class who

annoys him. Eddie, 7, has a strange habit of sticking his shirt in his

mouth and sucking on it.

Both were diagnosed with a form of autism. And it's partly because of

children like them that autism appears to be skyrocketing: In the latest

estimate, as many as one in 150 children have some form of this

disorder. Groups advocating more research money call autism " the

fastest-growing developmental disability in the United States. "

Indeed, doctors are concerned there are even more cases out there,

unrecognized: The American Academy of Pediatrics this fall stressed the

importance of screening every kid -- twice -- for autism by age 2.

But many experts believe these unsociable behaviors were just about as

common 30 or 40 years ago. The recent explosion of cases appears to be

mostly caused by a surge in special education services for autistic

children, and by a corresponding shift in what doctors call autism.

Autism has always been diagnosed by making judgments about a child's

behavior; there are no blood or biologic tests. For decades, the

diagnosis was given only to kids with severe language and social

impairments and unusual, repetitious behaviors.

Many children with severe autism hit themselves or others, don't speak

and don't make eye contact.

Blake Dees, a 19-year-old from Suwanee, Ga., falls into that group. For

the past eight years, he has been in a day program with intense

services, but he still doesn't talk, he's not toilet-trained and he has

a history of trying to eat anything -- even broken glass.

But he's not a typical case.

In the 1990s, the autism umbrella expanded, and autism is now shorthand

for a group of milder, related conditions, known as " autism spectrum

disorders. "

The spectrum includes Asperger's syndrome and something called PDD-NOS

(for Pervasive Developmental Disorder-Not Otherwise Specified). Some

support groups report more than half of their families fall into these

categories, but there is no commonly accepted scientific breakdown.

Gradually, there have been changes in parents' own perception of autism,

the autism services schools provide and the care that insurers pay for,

experts say.

Eddie, of Buford, Ga., was initially diagnosed with obsessive-compulsive

disorder, attention deficit hyperactivity disorder and other conditions.

But the services he got in school were not very helpful.

His mother, , said a diagnosis of autism brought occupational

therapy and other, better services.

" I do have to admit I almost like the idea of having the autistic label,

at least over the other labels, because there's more help out there for

you, " said Scheuplein.

" The truth is there's a powerful incentive for physicians and schools to

classify children in a way that gets services, " said Dr. Edwin Trevathan

of the U.S. Centers for Disease Control and Prevention.

Many with Asperger's and PDD-NOS succeed in school and do not -- at

first glance -- have much in common with children like Blake Dees.

At a recent gathering of families with Asperger's children in the

Atlanta area, parents told almost comical stories about kids who

frequently pick their noses, douse food in ketchup or wear the same

shirt day after day.

Such a frank, humorous exchange was once a rarity. Doctors for many

years believed in the " refrigerator mom " theory, which held that autism

was the result of being raised by a cold, unloving mother. The theory

became discredited, but was difficult to dislodge from the popular

conscience.

Even in the early 1980s, some parents were more comfortable with a

diagnosis of mental retardation than autism, said Trevathan, director of

the CDC's National Center on Birth Defects and Developmental Disabilities.

Today, parents are more likely to cringe at a diagnosis of mental

retardation, which is sometimes equated to a feeble-mindedness and may

obscure a child's potential.

And increasingly, professionals frown at the term: The special education

journal Mental Retardation this year changed its name to Intellectual &

Developmental Disabilities.

The editor said that " mentally retarded " is becoming passe and

demeaning, much like the terms idiot, imbecile and moron -- once used by

doctors to describe varying degrees of mental retardation.

In contrast, autism has become culturally acceptable -- and a ticket to

a larger range of school services and accommodations.

In 1990, Congress added the word " autism " as a separate disability

category to a federal law that guarantees special education services,

and Education Department regulations have included a separate definition

of autism since 1992.

Before that, children with autism were counted under other disabling

conditions, such as mental retardation, said Jim Bradshaw, an education

department spokesman.

The Social Security Administration also broadened its definition of

disability to include spectrum disorders, like Asperger's.

Something else changed: The development of new stimulants and other

medicines may have encouraged doctors to make diagnoses with the idea of

treating them with these drugs.

Perception of the size of the problem changed, too.

Fourteen years ago, only 1 in 10,000 children were diagnosed with it.

Prevalence estimates gradually rose to the current government estimate

of one in 150.

That increase has been mirrored in school districts. Gwinnett County

Public Schools -- Georgia's largest school system -- had eight

classrooms for teaching autistic youngsters 13 years ago; today there

are 180.

Some researchers suggest that as autism spectrum diagnoses have gone up,

diagnoses of mild mental retardation have fallen.

U.S. Department of Education data show that the number of students with

autism rose steadily, from about 42,500 in 1997 to nearly 225,000 in

2006. Meanwhile, the number of students counted as mentally retarded

declined from about 603,000 to about 523,000.

CDC scientists believe education numbers are misleading, because they

reflect only how kids are categorized for services. They say there's no

clear evidence doctors are substituting one diagnosis for the other.

Some parents believe environmental factors -- ranging from a

preservative in vaccines to contaminants in food or water -- may be

important contributors. (Since 2001, the preservative thimerosal has

been removed from shots recommended for young children, except for some

flu shots.)

Dr. Goldstein, scientific adviser to the national advocacy group

Autism Speaks, said the explanation for the rising autism prevalence is

probably complex. Labeling and diagnosing probably play a role, as do

genetics, but he believes the increase surpasses those two explanations.

" I'm seeing more children with autism than I ever would have expected to

see, " said Goldstein, who is chief executive of the Kennedy Krieger

Institute, a treatment center for pediatric developmental disabilities

in Baltimore.

Autism Speaks budgets more than $4 million each year to research the

causes of autism, and about 90 percent of that has gone to genetics

research. But organization officials recently have been talking about

changing that mix, and spending as much as 50 percent of that money on

potential environmental triggers, Goldstein said.

Whether it's because of genes or the environment (or both), autism has

hit the Massey family hard. Chuck and Massey, of Dacula, Ga., have

three sons with Asperger's.

The youngest, , was first diagnosed after he was slow to develop

speaking ability. His brothers -- Trevor, 14, and , 16 -- had

learning and behavior problems and were later diagnosed with Asperger's,

too.

All got special education services and were treated with medications.

has improved, or matured, or both, and is now a social kid in

mainstream classes at a Gwinnett County high school. Trevor seems to be

making the same transition, his mother said.

is the most extreme. He still has uncontrollable tantrums and must

attend an Asperger's-only sixth-grade classroom that teaches social

skills along with traditional subjects.

In a recent interview at the family's home, acknowledged he still

has anger control issues. One of the three other students in his class

is particularly irritating. said the way he reacts is by " grabbing

his throat. "

But on this night, was calm. He described himself as happy, and

paced the room telling jokes, like a nervous stand-up comedian. ( " Why

didn't the skeleton go to the party? He didn't have the guts, " he said,

eyes fixed on his audience.)

Having three Asperger's boys under one roof has at times been very

intense, Massey said, noting a replaced dining room window.

acknowledged it's been educational living in a house full of

Asperger's kids. Asked to name something he's learned from his brothers,

he replied, " Swears. "

© 2007, Telegraph Publishing Company, Nashua, New Hampshire

The material in this post is distributed without

profit to those who have expressed a prior interest

in receiving the included information for research

and educational purposes.For more information go to:

http://www4.law.cornell.edu/uscode/17/107.html

http://oregon.uoregon.edu/~csundt/documents.htm

If you wish to use copyrighted material from this

email for purposes that go beyond 'fair use', you

must obtain permission from the copyright owner*.*