As the national focus on the H1N1 pandemic rages, additional evidence of a more insidious epidemic has emerged, with an all-too-expected shrug from the mainstream media. Results from two federal studies announced in October say parents have a 1-in-100-or-greater chance of having a child with an Autism Spectrum Disorder (ASD). Since boys are four times more likely to have an ASD, their odds are as high as 1 in 60.
On Oct. 2, Health and Human Services (HHS) Secretary Kathleen Sebelius told the press and about 50 members of the autism community that an unreleased Centers for Disease Control and Prevention (CDC) study shows the incidence of 8-year-olds born in 1996 with ASDs is 1 in 100. The agency’s last two studies of children born in 1992 and 1994 put the chance at 1 in 150.
On Oct. 5, the journal Pediatrics published the results of HHS’s Maternal and Child Health Bureau’s “2007 National Survey of Children’s Health,” which showed 1 in 91 children between the ages of 3 and 17 had autism.
ASDs include Autistic Disorder, Asperger’s Disorder and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), which are characterized by lifelong developmental deficits in social, behavioral and communication skills. According to the CDC, citizens with ASDs “have significant impairments in social skills and communication. They often have repetitive behaviors and unusual interests.”
The National Survey of Children’s Health data was drawn from telephone surveys of 78,000 parents who said their children had been diagnosed and still have ASDs. While its methodology has been criticized, the results aren’t too far out of range of other recent reports.
In Indiana, a grossly polluted state with comparatively high rates of autism, data reported to the Indiana Department of Education, by every public school system in the state, have shown spikes in the numbers of children enrolled in special education under the category “autistic” over the past three years. The federally required counts are called Child Count Data.
“Last year 1 in 128 students were served under the eligibility category of Autism Spectrum Disorders,” Cathy Pratt, director of the Indiana Resource Center and chair of the National Autism Society of America, said for a story last spring. “This year’s identification rate is 1 in 113.”
In June, Pratt reported the latest figures in an e-mail to The Bloomington Alternative: “Now the Child Count Data is showing 1 in 101.” In another e-mail last week she confirmed its currency: “That is the latest data I have.”
As Huffington Post blogger David Kirby observed in his post of Oct. 9, the mainstream media’s response to the new CDC data has been “rather nonchalant.” But the implications of the new incidence measures are anything but mundane. They are “startling,” as Kirby, author of the best-selling book Evidence of Harm: Mercury in Vaccines and the Autism Epidemic: A Medical Controversy, says.
Improved diagnostics and changing criteria have long complicated the sometimes incendiary national debate about autism, its incidence and its causes.
The Diagnostic and Statistical Manual of Mental Health Disorders, Fourth Edition (DSM-IV), published in 1994, expanded the ASD criteria to include Asperger’s and PDD-NOS. So the 0.44 autism cases per 1,000 live births that the California Department of Health Services found in 1980, for example, couldn’t be accurately compared to CDC studies that showed the rate at 6.7 and 6.6 per 1,000 in 1992 and 1994. The California subjects were diagnosed before the DSM-IV changes, the CDC subjects after.
But the new 1-in-100 ratio of children born in 1996 appears to be a legitimate comparison. All three subject groups were identified under the same diagnostic criteria. And while the actual study will not be released until later this year, it doesn’t appear that the CDC has altered its methodology.
And federal officials’ reported response to the new numbers suggests drama. In an Oct. 5 piece in Age of Autism, Kirby described Sebelius’s call to the autism community as a “hastily arranged telephone ‘visit,'” during which she announced that the “prevalence of autism might be even higher than previously thought.”
The secretary then hedged a bit — “We don’t know if it has gone up, and we are hoping to unlock these mysteries.” — declared autism an “urgent public health challenge” and “promptly ended her visit,” Kirby continued.
The Associated Press reported on Oct. 5 that CDC announced the unpublished 1-in-100 findings “during an embargoed press briefing” in response to the published children’s health survey’s 1-in-91 rate.
Dr. Thomas R. Insel, director of the National Institute of Mental Health and chair of the Interagency Autism Coordinating Committee, provided more detail.
In an interview with the Chicago Tribune, he sounded a cautionary note similar to Sebelius’s. “It is not entirely clear what (the) increase is due to,” he said. “It is not clear more children are affected rather than just changes in our ability to detect.”
Another interview with an AP medical writer was more sobering. “The concern here is that buried in these numbers is a true increase,” Insel said. “We’re going to have to think very hard about what we’re going to do for the 1 in 100.”
No one knows what causes autism, let alone what is responsible for the statistical evidence that its prevalence is spiking. “Honestly, if someone was going to give a talk on the etiology or causes of autism, it would be entirely speculative,” according to Dr. Christopher McDougle, an autism researcher and chair of the psychiatry department at the Indiana University School of Medicine. “There’s nothing that’s known.”
Research has focused on perinatal and prenatal causes, he said, because autistic symptoms appear between the ages of 1 and 1½. Prenatal suspects include fetal damage from medications, abnormal brain development from genetic causes or infections. Contributing factors at birth could be prematurity, lack of oxygen to the brain, prolonged labor or infections. Shortly after birth: infections or environmental contributions.
A growing number of researchers believe that autism is triggered in genetically predisposed individuals by an “environmental hit,” McDougle said.
Count Kirby among those who argue that environmental pollution is the likely culprit in the autism epidemic. Federal health officials who led the AP to report, “Greater awareness, broader definitions and spotting autism in younger children may explain some of the increase,” are misguided, he argued.
“Some have called it ‘good news’ that doctors are now so proficient at diagnosing the milder forms of ASD,” Kirby wrote in the Huffington Post. “… Many will call me an alarmist, but I believe that 1-in-60 boys with an autism spectrum disorder is a national crisis — and not just a reassuring confirmation of how things have always been.”
Plus, he added, to buy that argument is to accept the conclusion that 1-in-60 American males, young and old, have an ASD. “Do you really believe that 1 in 60 American men are autistic?” he asked.
For Kirby, the parallel rise in environmental pollution and autism rates are related. And federal officials need to shift their focus accordingly.
“They don’t seem to feel that rising levels of environmental toxic exposures in genetically susceptible children might also be at play here,” he wrote in the Huffington Post. “I personally believe that toxins like mercury can trigger ASD in children. These toxic exposures are on the rise, and so is the incidence of ASD.”