The results of a 2014 survey* by the National Center for Health Statistics revealed an explosion in the rates of autism in US school-aged children when it was released on November 13, 2015. The previous survey, taken between 2011 and 2013 had estimated the autism rate at 1 in 68 children. At first glance, this seems to reflect a surge in an ongoing epidemic. While the new estimates are likely could be a more realistic snapshot into the true incidence of autism in the US than as previously counted, it is essential to put the new numbers into perspective. There are factors that may not be as straight-forward as they seem.

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Overall rates may not have changed

Changes to the way parents were questioned were adjusted. The questions regarding autism were adjusted to be more specific in the most recent health survey. While previous surveys mixed having an autism diagnosis in with a list of other health concerns, the latest questionnaire asked specifically whether or not a child had been diagnosed by a physician with autism, which included diagnoses of autism, Pervasive Developmental Disorder (PDD), Asperger’s disorder, or an autism spectrum disorder.

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While the statistics for autism spiked, in part as a result of this very specific questioning, the rates of “other developmental disorder” (ODD) dropped almost as dramatically. Logically, adding Asperger’s and PDD to the autism spectrum disorder qualifier in both the last version of the DSM and this survey may have moved a subset of children with developmental or neurological differences from the ODD category to being counted among the autism rates.

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Therefore, while the reporting is different, the rates of a variety of conditions being grouped under the autism spectrum may very well be in the same ballpark as the previous few years, this may simply be a better representation of how often it is being diagnosed in real life.

Limitations still exist

When reviewing the data, white males with health insurance, a two-parent household and at least one parent with a higher education make up the preponderance of the children with an autism spectrum diagnosis.

In fact, uninsured children only account for a very small fraction of autism diagnoses. It is certainly possible that if genetics are the main cause for neurodevelopmental disorders that males of European heritage may simply have a higher incidence rate than all other groups. In addition, due to the fact that the question was verbally geared toward “ever” having a diagnosis of an autism spectrum disorder that misdiagnoses are also being represented in the count.

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However, it seems that gender and socioeconomic status must play a part in the imbalance. Previous studies have clearly indicated that female symptoms, for example, are often different than those of males and may be missed or misinterpreted as depression, anxiety, or other psychological disorder. The lack of even representation of other races, children of single parents, parental education levels and health insurance status indicates that perhaps, in some ways, true rates may be underrepresented in those children with fewer economic resources that impact their ability to get a proper diagnosis.

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Looking forward

In any case, this new snapshot at prevalence, whether over or under representing a true number by a few decimal points, should be a wake-up call to the way the US views the support, educational needs, and medical needs of a growing population. These children will grow to adults, joining many current adults with autism in the US, who will need continued support that is currently not available at the quality or quantity required to meet their needs.

 

*13Nov2015 Benjamin Zablotsky, Ph.D. and Lindsey I. Black, M.P.H., Matthew J. Maenner, Ph.D., Laura A. Schieve, Ph.D., Stephen J. Blumberg, Ph.D., Estimated Prevalence of Autism and Other Developmental Disabilities Following Questionnaire Changes in the 2014 National Health Interview Survey

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