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Autism May Be More Common Than Thought

by Sue Hubbard, M.D.

After reading the newest studies that were just released regarding the prevalence of autism, I thought it was important to discuss the findings.

The study “The Prevalence of Parent-Reported Diagnosis of Autism Spectrum Disorder (ASD) Among Children in the United States, 2007” was published in this months Pediatrics. The study was based upon telephone interviews (parents of 78,037 children ages three to 17) conducted by both the Health Resources and Services Administration and the U.S. Centers for Disease Control and Prevention (CDC).

The newest findings reported the prevalence of autism to be about 1 in 100 children, rather than previous reports of prevalence of 1 in 150, which was reported by the Autism and Developmental Disabilities Monitoring Network in 2002.

The design of this study is different from previous studies and was based upon parental reports rather than upon review of medical records or confirmation of the clinical diagnosis by a physician. The study also found that boys were affected four times more often than girls. And white children were affected more often than black, Hispanic and multiracial children. The prevalence was higher in children in the Midwest and Northeastern part of the U.S. Interestingly, half of the parents surveyed reported their children to have “mild” autism, another one-third said moderate, and the remaining parents described severe autism. But, mild, moderate, and severe were not defined within the article.

There may be several reasons for the increased prevalence of autism including earlier diagnosis by physicians. Over the last five years the information regarding screening for autistic spectrum disorders has been widely distributed with increased awareness among pediatricians. As pediatricians are using newer screening and diagnostic tools to aid in earlier diagnosis of any “behaviors” that fall within the realm of ASD, there may be an increase in the diagnosis of ASD. It is also not uncommon to have physicians “code” language delays or mild cognitive developmental delays under the ASD umbrella in order that a child may receive services for remediation, either within a school setting or privately. Parents of these children may have reported their child to have “mild” autism when asked during the telephone survey. Again, prevalence and incidence (new cases) are not the same, and this data looked at prevalence.

Another area of interest in this article was the fact that about 38 percent of the children identified as having a diagnosis of autism, “lost” their diagnosis over time. This too may be related to the fact that children who received a diagnosis within the ASD umbrella, actually had other developmental delays that were reclassified at a later time as the child became older. It is not uncommon to see language delays, processing disorders, behavioral problems and ADHD all present at a younger age in a non-specific manner, and over time the actual diagnosis may be made. In other words, moving from a broad ASD diagnosis to a more narrow and specific learning disability might then appear to be a “ recovery” from autism.

It is important to have continued studies to try and identify causes and trends in autism. Regardless of which study we read, it seems that ASD in on the rise. There are many factors that continued to be studied including genetic factors, environmental factors and how prematurity and advancing paternal age may also impact the development of autism.

The research is continuing in each of these areas, and prospective long term studies will need to be done to further clarify factors that may impact the development, either prenatally or postnatally of autism. It is of utmost importance that pediatricians continue to be vigilant in screening for autistic tendencies and provide intervention whenever there seem to be a concern surrounding a child’s development. The one consistent message in each study is that early intervention provides a better outcome.

That’s your daily dose, we’ll chat again tomorrow.

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