There is no autism epidemic

One argument made by people opposed to vaccination is that autism is new, caused by vaccines, and is an epidemic. In the film Vaxxed, which I watched and reviewed here, the filmmakers quote Dr Stephanie Seneff, a computer scientist, as saying that by 2032, 80% of boys, 50% of all children, will be on the autism spectrum.  Respectful Insolence blog has done a nice job of debunking Seneff’s claims. Even though we know Dr Seneff is wrong, there are people who worry she could be correct.

I have already shown you how vaccines do not cause autism.  That argument involved looking at autism and immunization science. We also know that autism diagnosis has shifted a great deal.  This paper explains how “the second edition of the DSM, the DSM-II, published in 1952, defined autism as a psychiatric condition — a form of childhood schizophrenia marked by a detachment from reality.”  Since that time, the diagnostic criteria for autism has shifted and grown to now be a spectrum and it includes behaviors we previously ignored or diagnosed as schizophrenia, intellectual disability, emotional disturbance, or specific learning disability.  Tara Haelle explains diagnosis shift nicely in this article for Forbes.

Some people don’t trust the science. If you discount the science because you do not trust it, there is another way of making this argument and it debunks the idea that autism is new and an epidemic. This way uses logic, which is reasoning conducted or assessed according to strict principles of validity. This is not about feelings. This is like how Mr Spock from Star Trek talks and reasons.

 

Logic statements have rules or conditions. They are called conditional statements. for example,  “If all philosophers are thinkers and John is a philosopher, then John is a thinker,” is logical because if one is true and the other is true, then the third must be true.

 If the mental retardation and schizophrenia rates in USA used to be 3-5% and the current diagnosis of similar behavior is now called autism or intellectual disability and rates are currently 3-5%, then the autism rate is not increasing. 

Autism is not new. Mental retardation and schizophrenia rates have decreased as autism and intellectual disability rates have increased. This is because we have new terms for behaviors which have been in humanity for all eternity. A current diagnosis of autism includes behaviors we formerly diagnosed as mental retardation. Look at this meme from RtAVM. It makes the point visually.

Source

First, a bit of history. Prior to the early 1900s, we did not have many good tools for diagnosing and treating people who had any differences from the “norm” with regards to their thinking and behavior. Gradually, the fields of psychiatry and psychology, as well as other social and behavioral sciences, have learned more and more about human behavior and the brain.  In his book, Neurotribes, Steve Silberman goes through the “earliest days of autism research” and he  chronicles “the brave and lonely journey of autistic people and their families through the decades.” I highly recommend this book as a starting place for anyone wanting to learn about the history of autism.

Prior to the 1970s, we did not have special education in the USA. Two legal cases from the early 1970s, Pennsylvania Assn. for Retarded Children v. Commonwealth of Pennsylvania (PARC) and Mills v. Board of Education of District of Columbia, paved the way for more laws that have led to what we know today as special education. In 1972, Congress decided to investigate how children with disabilities were living and found many problems, including lack of education. In 1975, they passed The Education for All Handicapped Children Act. Congress has since amended and added to it and renamed it IDEA, The Individuals with Disabilities Education Act.

Since 1975, more and more children are now educated in schools and, in order to do so, many changes have been made to medical and educational diagnoses for behavior and disabilities.  When I was a young child, in the early 1970s, we did not find any children with disabilities in the schools. My mother paid for private tutoring for my brother, who had a mild reading issue. There was no reading specialist in schools. Children with severe disabilities were institutionalized and children with mild disabilities struggled and often dropped out of school. Children with behavior issues fared poorly in school. Many school-related issues were blamed on the child or on parenting practices. All that has changed, thanks to IDEA, including the labels we give to children to enable them to get the services they need.

Before IDEA, a diagnosis of autism was rare. More likely, children with severe symptoms were labelled “mentally retarded” or “schizophrenic.” Yes, you read that correctly. Please continue to read as I explain.

In an analysis of the prevalence of mental retardation, Dutch epidemiologists Roeleveld and Zilhuis looked at rates for severe MR as well as mild from 1939 through 1986. They concluded, from looking at data from many countries, including USA, that the rate of mental retardation in children was 3%.

Now, look at the graph below. Yes, I know some of you don’t like Autism Speaks, but I am using this graph to make a point. The rate of autism appears to have risen dramatically since 1975. But, Autism Speaks published this graph and stated “approximately 53% percent of the increase in autism prevalence over time may be explained by changes in diagnosis (26%), greater awareness (16%), and an increase in parental age (11%).”  They acknowledge how the increase has many factors behind it.

Today, in 2016, the Autism Science Foundation says the rate of Autism in USA is 1 in 68, which is 1.47%. Others think the rate of autism is 1:45, which is about 2%.  As of 2014, an estimated 5.4% of children between ages 5 and 17 qualify as disabled in some way. This includes hearing and vision disabilities as well as ambulatory disabilities and all other categories of disabilities. According to the National Center for Education Statistics, 14% of public school children qualify for special education services under IDEA. This includes children with speech and language impairments, learning disabilities, and many other categories. (Remember, none of these children would have had services at all prior to IDEA). Of those 14%, 8% are labelled autistic and 7% are labelled with an intellectual disability (ID). Thus, 1.12% and 0.98%, respectively, of public school children are autistic or have an ID. This comes to 2% of public school children. Doubtless, there are also children with ID or autism diagnosis not in public schools so, for the sake of the argument, let’s assume the autism plus ID rate is at least 2% in real life, in USA.

We no longer use the term “mentally retarded.”  So, what happened to it?  Are there no longer any children suffering symptoms we used to label “MR?”  Far from it. We changed the diagnosis from mental retardation to autism and intellectual disability. We know a lot more today than we used to about how intellectual quotient (IQ) tests are not the best way to define a person’s abilities.  In 1941, mental retardation was defined as social incompetence associated with deficits in mental ability. In 1959, it was “subaverage general intellectual functioning which originates during the developmental period and is associated win adaptive behavior.” In 1973, the definition changed again, to subaverage general intellectual functioning.

Meanwhile, according to Autism Speaks,  in the 1970s, autism was beginning to be understood as “a biological disorder of brain development.” In the 1980s, the diagnosis manual (DSM-III) first distinguishes autism from childhood schizophrenia and then the DSM-IIIR showed a checklist of criteria for diagnosing autism. By 2000, the DSM-IV and DSM-IV-TR had expanded the definition of autism to include Asperger’s syndrome. In 2015, a Danish study found the “vast majority of people diagnosed with autism spectrum disorders today would never have qualified under the 1980 classification, and no formal classification separate from schizophrenia existed before then.” Dr Jess P Shatkin writes that most of the early work on childhood “schizophrenia” was really about autism. We also know that in the 1940s, Leo Kanner and Hans Asperger delineated two forms of autism out of the pool of schizophrenia psychoses. Back then, anyone who would today have been labelled Aspergers would have just been called odd. Aspergers did not become an official diagnosis until 1994. Currently, we no longer commonly diagnose children as schizophrenic. Today, this is a very rare diagnosis.

Since the 1970s, thanks in part to IDEA and related research, the diagnosis of mental retardation has been used less and less. Gradually, the shift was made to using the term intellectual disabilities. In 2013, the term “mental retardation” was struck from federal registers by President Obama. It was replaced with the term “intellectual disability.”

 

Update 8/30/19: Something else I recently found is that the numbers of children, in the thousands, who qualify for special education services in the USA have not changed much since 2000. From a report by the National Center for Education Statistics,  in 2000 we had 6,300,000 children with disabilities received services in American schools.  By 2016, that number was 6.677,000 which is not a significant increase. The number of children with a diagnosis of autism rose from 93,000 in 2000 to 617,000 in 2016 while emotional disturbance diagnosis decreased, in the same time period, from 480,000 to 347,000 and intellectual disability decreased from 624,000 to 425,000. The percent of American children receiving services in special education in 2000 was 13.3% and it was 13.2% in 2016.

 However, there were different patterns of change in the percentages of students served with some specific conditions between 2004–05 and 2015–16. The percentage of children identified as having other health impairments (limited strength, vitality, or alertness due to chronic or acute health problems such as a heart condition, tuberculosis, rheumatic fever, nephritis, asthma, sickle cell anemia, hemophilia, epilepsy, lead poisoning, leukemia, or diabetes) rose from 1.1 to 1.8 percent of total public school enrollment; the percentage with autism rose from 0.4 to 1.2 percent; and the percentage with developmental delay rose from 0.7 to 0.9 percent. The percentage of children with specific learning disabilities declined from 5.7 percent to 4.6 percent of total public school enrollment during this period.

 

The point: it is logical to conclude that the number of children we serve in special education in the USA has not changed much in 20 years but the diagnoses we give them has changed as we learn more.  The rate of autism has not changed much in the 100 years we have been tracking these kinds of diagnosis. We have just changed the name for it. Three percent (3%) of public school children fall in the autism or intellectual disability diagnoses. This is a similar rate to the mental retardation and schizophrenia rates of yesteryear.

 

Autism is not new.

 

 

Remember to think for yourself.

 

Kathy