Record Straight: Inventing the autism epidemic

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"As Chair of the DSM-IV Task Force [that prepared the Diagnostic and Statistical Manual of Mental Disorders in 1994], I bear partial responsibility for the false epidemic of autistic disorders," Dr. Allen Frances confessed to the Psychiatric Times. Autism, a neurodevelopmental disorder marked by severe speech and socio-emotional impairment, had a prevalence of 2-4 per 10,000 children for nearly five decades after it was first described in 1943.

Since 1994, however, when the American Psychiatric Association (APA) expanded the diagnostic criteria for autism in its official manual, the prevalence of autism has increased by twenty-fold (Journal of Developmental & Behavioral Pediatrics: Frances and Batstra, 2013). Dr. Frances is right to question the veracity of the autism epidemic, as the dramatic surge of diagnoses over recent decades does not coincide with an increased incidence of autism in the population.

A 2005 UK study, which tracked the frequency of autism diagnoses in a sample of 10,000 children, found that the rate was higher than that reported in 1990 (Scientific American: "Is There Really an Autism Epidemic?;" Aug. 2012). Another conclusive study, examining the prevalence of autism in 677,915 Danish children born between 1980 and 1991, proved that 60 percent of the increase could be attributed to the broadening of clinical criteria for autism after 1994 (JAMA Pediatrics; Jan. 2015). Therefore, these revised diagnostic markers have contributed to the present epidemic of over-diagnosing autism.

The DSM-IV classified autistic behavior under five distinct subcategories (e.g. Autistic Disorder, Asperger's Disorder), but medical practitioners widely differed in assigning these sub-diagnoses. The lack of consensus raises pressing questions regarding the current clinical process of accurately identifying and diagnosing autism in young children. Unfortunately, instead of investigating the causes of such discrepancies, the most recent edition of the psychiatric manual, the DSM-5 (2013), replaced the subcategories with a catchall category called "Autistic Spectrum Disorders" (ASD). The new criteria have only exacerbated the over-diagnosis of autism. Last year, 1 in 68 US children was identified with ASD, which represents a startling 30 percent hike from 2012 (Time: "This May Explain the Rise in Autism Diagnoses;" Jan. 2015).

The incredible rise in occurrence likely stems from the conflation of developmental delays (eventually overcome with age and/or treatment) and permanent neurological disability. This assertion is supported by a 2015 government study, which shows that more than 9 percent of children diagnosed with ASD are mislabeled, and that 4 percent of children with ASD eventually lose the diagnosis through early intervention and other therapies (NBC: "Study Suggests Autism Is Being Overdiagnosed;" Oct. 2015).

As anxious parents scramble to find causes for what they believe is a looming public health crisis, many have been swayed by junk science peddlers - la the dangerous anti-vaccine movement. Moreover, mental health professionals that substitute context-providing psychotherapy with the flawed practice of checklist diagnosing, as well as untrained teachers inundated with media hype, have been identifying ASD symptoms where none exist.

Diagnostic inflation in fact, derives from a growing politico-cultural trend to medicalize normal behavior of children. In his book, "Back to Normal: The Overlooked, Ordinary Explanations for Kids' ADHD, Bipolar, and Autistic-Like Behavior" (2013), clinical psychologist Enrico Gnaulati describes our society's rush to pathologize children with "troubling and troublesome behavior." Similarly, researchers Til Wykes and Felicity Callard note that the DSM-5 is a "more inclusive system of diagnoses where the pool of normality shrinks to a mere puddle" (Journal of Mental Health: "Diagnosis, diagnosis, diagnosis: towards DSM-5;" 2010).

In addition, casting as wide a diagnostic net as possible enables the upcoding of developmental delays and mild psychiatric problems to the autism spectrum. Recent studies suggest that the pursuit of secondary gains, by clinicians and educators, incentivizes this problematic phenomenon (Frances and Batstra 2013; Basu and Parry 2013). The benefits include increased Medicare reimbursement payments to medical providers; lucrative deals with pharmaceutical companies in search of new markets for existing drugs; and greater financial assistance for schools with special needs students. No wonder that autism has become something of a diagnosis du jour.

Ultimately, the children who have been wrongly classified as autistic will pay the price for the over-diagnosis epidemic. They will have to undergo inappropriate treatments, and unnecessarily face a whole host of negative consequences that accompany the label of a lifelong mental impairment (note: two-thirds of autistic individuals exhibit mental retardation).

The APA's diagnostic manual is afforded unquestioned authority even though unsound science, political motivations, and financial conflicts of interest (with drug companies) are known to influence its development. Indeed, without comprehensive ethics oversight, psychiatric diagnostic fads will endure, and the medical sins of each generation will be visited upon the next.

Meg Hansen is a writer from Windsor. She studied medicine in a First Professional Degree program (MBBS) at Kasturba Medical College in India

The opinions expressed by columnists do not necessarily reflect the views of the Bennington Banner.


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