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Posts tagged ‘dsm’

What does the new data from the CDC actually mean regarding autism?

With this month being autism awareness month and the CDC’s publishing that autism is now 1 in 54 males, and 1 in 212 females with an overall prevalence of 1 in 88, I am inclined to write about how I feel about this.  And in reality I am not sure.   If you take it at face value, autism has increase 23% since 2006.  This is when there was 1 in 110.  And if compared to 1980, the increase is even more incredible.

The problem with looking at this increase is the change in the inclusion criteria.  Whereas in 1980, only the most severely affected was diagnosed.  Those with Aspergers would not have been included, and neither would others on the spectrum.  And if you look at the spectrum, well the entire one actually includes ADD/ADHD.  And recent reports indicate when DSM-V will actually narrow the inclusion criteria, so will the numbers go down?

I thought about my own practice, am I seeing these numbers or am I missing some.  While I might be able to accept the number of girls, I am uncertain about the amount of boys diagnosed.  Am I missing that many?  Or is my practice just not have that many in particular, and some other practice has a greater proportion?

Another angle to look at is the fact that there is increased awareness of the disorder and an increase in the ability to treat.  This happens with all disease states, and often the increase occurs after treatment has been accepted and become routine.  So there is also that.

The other concerning bit of data, is that those that are diagnosed earlier are still sitting at the same frequency.  The diagnosis of the older child (meaning 6 to 8) is actually increasing.  Why wouldn’t it increase in the earlier ages?  Are we still lacking in the ability to fully diagnose the younger children?  Or are those that are getting diagnosed at an earlier age actually suffering from something else?  Maybe that is why they didn’t show the signs earlier because they aren’t autistic.  This is purely a thought on my part

And I often wonder about those doing the diagnosis.  I don’t have time in my office to do the entire diagnostic test.  I wonder if these children with the diagnosis are from the physician (pediatrician or family practice) or if they went to a developmental psychologist or developmental physician.  Sometimes what appears to be true in a 15 minute office visit might be masking something else.  I am not saying that this is the case for all those with the diagnosis, but without access to the entire set of data, the report raises more questions than it answers.  And to be honest, I don’t have time to pour through the data, but I do have many questions, as I compare it to my practice.

In the end, the new report doesn’t answer much.  There are many dedicated scientists who are working on the answers as to who and why.  And they are determining why it appears in one child in a family and not necessarily others.  They are looking into environmental factors and what triggers the expression and why presents in one why and why another.  And there is seeming to be an increase in incidence in children with older fathers, as opposed to many of the other developmental conditions with increased risk in the mother.  Dr Kevin Pelphrey discusses this in his talk with the Autism Science Foundation.(1)

If anything, the report indicates the need for further research.  The need for diagnostic tools to diagnose earlier to start therapy earlier and other recognized effective treatments.  And the need for making sure that it is the diagnosis.  Unfortunately, there is no blood test for autism.  The tests use diagnostic tools which help to indicate whether or not the child meets the criteria.  There are new studies using functional MRI underway which are showing some differences in brain function in infants that later on have the diagnosis of autism, and while exciting, there are still in the study phase.  And in reality, out of reach for many clinicians across the country.  And how do you justify ordering a functional MRI on a seemingly normal infant?  

So to me, this report raises more questions than it answers.  And I will wait to determine whether I accept the report on face value until more data is released.  What it does do is illustrate the need for further research into early detection, and why some children develop autism and some don’t.  We need to look at the environment, both what is around us and what we are ingesting, and above all look at siblings, why does one sibling show signs and another doesn’t.  And why is the incidence so much higher in boys than girls?  But we do need to have a consistent diagnostic criteria, because right now the  ever changing criteria means that we are comparing granny smith apples to apples in general.    

 

1.  Autism Science Foundation: Chat with a Scientist- Transcript: Chat with Yale Autism Scientist Dr. Kevin Pelphrey, April 6, 2012 found online at http://www.coveritlive.com/index2.php/option=com_altcaster/task=viewaltcast/altcast_code=ce2c575ca5/height=550/width=470

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