Saturday, March 1, 2008
Is there an Austism Epedemic?
We've seen the celebrity fund raisers, car ribbons and bracelets. Autism has become a common household word, where, maybe twenty years ago, the diagnosis of Autism was rare. Autism rates have been steadily rising since the mid nineties. Parents and professionals alike call it an epidemic. Roy Richard Grinker author of "Unstrange Minds" disagrees with the term "epidemic". The word itself implies that it is a contagious disease. Autism is obviously not contagious and appears to be genetic, although that has yet to be determined. It also suggests that there are more people today with autism than there were in the past. Grinker, as well as myself disagree with this. Using the history of psychiatry and modern diagnostic techniques, some plausible reasons for the rise in autism cases can be seen.
Awareness plays a huge role in diagnosis. As I said earlier, autism awareness has made its way into pop culture, and medical settings. Mainstream teachers, psychologists, clinicians and parents are educating themselves thanks to the growing resources on the internet and peer reviewed journals. Because of this, the behaviors of an autistic individual are more recognized leading to an earlier and more appropriate diagnosis. A child with Aspergers ( a high functioning form of autism) would have been seen as socially awkward years ago when the diagnosis didn't exist. Many historical figures have been believed to have autism, from Einstein, to many of the great poets and writers. On the other end, children with low functioning autism were noticed but had a completely different diagnosis. Many times it was mental retardation or childhood schizophrenia. They were put into institutions by well meaning psychologists that no idea that there was such a thing as autism. Reading old mental health journals, reports and case studies, there are many individuals that displayed obviously autistic behaviors. They just held a different diagnosis. Like Newton (ironically another hypothesized autistic) "discovering" gravity when it has always been there, so to with autism. There were always people with autism, they just went under a different name.
There are economical reasons for autism cases as well, and this is not necessarily a bad thing. In some states a child can only receive insured care with a diagnosis of autism. A clinician may see a child that needs help, for example a child have a developmental delay, or even mental retardation, but insurance may not cover specialists, such as SLPs. for those diagnosis. So they diagnosis them with autism instead. Sometimes it is so the child can receive more appropriate therapy. Most clinicians have the sense to diagnose to the benefit of the patient, even if it is not by the book.
In this country at least there is less stigma attached to autism. Up until almost the seventies the blame was placed on the so called refrigerator mothers. Mothers were to blame for everything, from their genetics, to their work choices, to their motherly care. They were hesitant to have their child receive a diagnosis of autism, because it reflected poorly on them. Fortunately modern research has shown that this is not the case and autism isn't something to be hidden away from the world and the diagnosis is welcome. In other countries this isn't the case. I won't talk in length about it but some other countries have a very interesting and unfortunately negative view on autism, such as South Africa, India, Korea and France. This countries, even today, have been known to put autistic individuals in cages or to exorcise them. I don't want to give the wrong impression of these countries, or make them seem backwards. The parents (usually mothers, but not always) are just as caring there as they are here.
Finally I can talk about my experience ( how little there has been so far). Autism has almost become the preferred diagnosis. It seems to give hope, where there is no hope with mental retardation. There is less impairment. They can be "cured". It is almost fashionable. I have had parents convinced their child has autism, and want their child to be put through every test imaginable, from MRI's to standardized tests. When anything but an autism diagnoses comes back, the SLP is the incompetent one. Parents are misled by youtube videos, and anecdotes on the web. They mean well, they love their children, but this insistence on having a certain label is certainly something to think about. Of course this is a completely subjective field. Every clinician can look at an individual and come up with something different. The most important thing, no matter what the numbers, or parental pressure, is that the patient gets the most beneficial care possible.