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Education Reporter

Autism Diagnosis Has Changed Over Time
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The American Academy of Pediatrics wants to screen every child for autism twice before the age of two. The urgency of the academy's demand arises partly from the appearance of a shocking rise in the incidence of autism — from 1 in 10,000 children in 1993 to 1 in 150 children today. Autism research advocacy groups call the disorder "the fastest-growing developmental disability in the United States."

As with so many reports on behavior disorders in children, there is more to the autism "epidemic" than meets the eye. Some experts believe that the behaviors now diagnosed as "autism" were just as common or nearly as common in past decades as they are today. The skyrocketing numbers result at least partly from the changing definition of the term, and from parents' and doctors' changing perceptions of the autism diagnosis.

Professor Stephen Camarata of Vanderbilt University has worked with autistic children for over 20 years. Those with "true autism" according to the original definition, Camarata says, are "very difficult to treat and may never say 'mommy' or learn to take care of themselves without Herculean efforts by their parents and teachers." The original autism diagnosis covered only children with severe social and language impairments, often including complete disengagement from the world around them, or violent behaviors toward themselves or others. These children also often displayed unusual, repetitive behaviors such as compulsively eating non-food objects or rocking back and forth for most of the day.

Children with these behaviors are still diagnosed as autistic. Today, however, children with much less severe problems also receive the diagnosis of autism because their problems are labeled as "on the autism spectrum." Disorders on the autism spectrum include Asberger's syndrome and PDD-NOS, which stands for Pervasive Developmental Disorder-Not Otherwise Specified. It is not known how much the broader diagnosis contributes to the apparent drastic increase in the incidence of autism.

An Associated Press reporter who attended the meeting of an autism support group in Atlanta remarked on some of the relatively mild problems parents complained of there. Their children might pick their noses or want to wear the same shirt day after day, but such problems hardly compare to the behaviors severely autistic children exhibit (Associated Press, 11-4-07).

Because of the extreme severity of autism's most serious cases, the government has made a wide variety of services available to autistic children and their families. Thomas Sowell reports in National Review (11-14-07) that he has heard of many families who were "urged to let their children be labeled autistic, or on the autistic spectrum, in order to get money for speech therapy or other [services] from grants that are available to deal with autism." Children with the same problems would not receive such comprehensive services for other diagnoses such as obsessive-compulsive disorder, ADHD or even mental retardation.

Other experts believe that both labeling and an actual increase in all levels of autism contribute to the higher prevalence of the diagnosis today.

Whatever the cause of rising autism diagnosis rates, screening such as that urged by the American Academy of Pediatrics could lead to a vast number of "false positive" diagnoses, Thomas Sowell warns. Autism screening relies on a checklist of symptoms that infants and toddlers with or without autism or autism spectrum disorders may display. Some children begin talking much later than others for no known or significant reason. Children with very high IQs often begin talking late, and show other characteristics that may result in a false autism diagnosis.

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