In the last four years of my work as a family therapist, I have had nine cases where the families have come in with an autism diagnosis, and not one met the DSM-4 criteria, let alone Kanner's original criteria. Only two cases barely met DSM-5 ASD criteria, and even then, the children met it at the time of testing years ago, but not presently.
If the rate of autism hasn't gone up, there should be some hard evidence (not anecdotes) of the multitudes of undiagnosed or misdiagnosed seniors.
Or do want to claim it's all overdiagnosis? In that case, why is there a rise of low-functioning autism as well, with no comparable drop in other diagnoses such as ID?
The rise of autism has occured globally since the 1980s in many countries with very different health systems, different policies, and different incentives. How many modern, industrialized countries, on which we have good data, have seen a drop in their autism rates over the last thirty years? Or even a stable rate?
Unless you recognize that environmental factors are at play here (not vaccines, obviously, since that hypothesis was thoroughly examined and disproven years ago), you'll have to keep torturing and explaining away the data.
As noted in the article you're commenting on, readers were expected to have read the linked prior article. You didn't read it. Everything you said was addressed there.
I'll link it again. Do not be ignorant in my comments section again.
I have read it in the past, actually, and I didn't find it to be convincing, especially not as to explaining the global, simultaneous rise.
You even admit yourself in the post that there might be a true increase, but attribute it to factors like older parents. You also agreed with someone in the comments that assortative mating can be a factor.
So you have no problem acknowledging that there might be a true increase, so long as it's attributed to factors you deem acceptable. This seems like motivated reasoning.
The rise isn't identical everywhere, so your first point is a non-point.
Before the DSM-III, autism was not commonly known and diagnosis was rare and idiosyncratic due to the extremely high standards for diagnosis. And yes, before the DSM-III, nowhere had diagnosis incentives.
You don't understand the background of this phenomenon even though you've had the chance to read about it.
It's not identical, but we've seen a similar increase in many countries at around the same time period (the UK, Canada, several European countries, Japan - studies provided in the first link.)
The DSM-III was published in 1980, yet the rates remained low in many places and only started increasing in the 1990s and 2000s.
And the causality isn't clear here at all. Was autism not commonly known in the past because of the high standards of diagnosis? Or was it not commonly known in the past because it was actually rare?
The conclusion: "It evidenced that there has been a rise in ASD over time, that methodological differences cannot account for a significant amount of the variability between prevalence estimates and that changes in diagnostic criteria are not sufficient to explain the observed increase in ASD."
Thank you for writing this detailed post! Let me add two minor suggestions.
First, NIH needs to focus research dollars on the profound end of the autism spectrum and heavily scrutinize study proposals that fail to deliberately consider profundity. Kids with level 1 autism who are fine in a general education classroom just aren’t the same as level 3 kids who need a high-intensity special ed setting, but it’s much easier to recruit level 1 kids and make over broad claims about your results.
Second, all of these programs need a fast-track approval process for genetic diagnoses with autism as a secondary diagnosis. Kids with, say, Angelman Syndrome aren’t going to stop needing a high amount of services. Genetic screening these days is cheap enough that private insurance encourages it and provides fast-track approvals for kids with genetic disorders.
If it works as well for mental retardation as for autism, that's news to me. But also, there's more to diagnostic substitution than just swapping for mental retardation. Autism gets swapped with tons of different disorders.
You wrote all this in one hour? You must be more autistic than me. (I mean that as a great compliment.)
In the last four years of my work as a family therapist, I have had nine cases where the families have come in with an autism diagnosis, and not one met the DSM-4 criteria, let alone Kanner's original criteria. Only two cases barely met DSM-5 ASD criteria, and even then, the children met it at the time of testing years ago, but not presently.
You've cherry-picked the evidence here, ignoring most epidemiological and administrative data, in addition to common sense observations.
https://www.ncsautism.org/blog//autism-explosion-2024
If the rate of autism hasn't gone up, there should be some hard evidence (not anecdotes) of the multitudes of undiagnosed or misdiagnosed seniors.
Or do want to claim it's all overdiagnosis? In that case, why is there a rise of low-functioning autism as well, with no comparable drop in other diagnoses such as ID?
The rise of autism has occured globally since the 1980s in many countries with very different health systems, different policies, and different incentives. How many modern, industrialized countries, on which we have good data, have seen a drop in their autism rates over the last thirty years? Or even a stable rate?
Unless you recognize that environmental factors are at play here (not vaccines, obviously, since that hypothesis was thoroughly examined and disproven years ago), you'll have to keep torturing and explaining away the data.
Don't lie in my comments section.
As noted in the article you're commenting on, readers were expected to have read the linked prior article. You didn't read it. Everything you said was addressed there.
I'll link it again. Do not be ignorant in my comments section again.
https://www.cremieux.xyz/p/whats-the-deal-with-autism-rates
I have read it in the past, actually, and I didn't find it to be convincing, especially not as to explaining the global, simultaneous rise.
You even admit yourself in the post that there might be a true increase, but attribute it to factors like older parents. You also agreed with someone in the comments that assortative mating can be a factor.
So you have no problem acknowledging that there might be a true increase, so long as it's attributed to factors you deem acceptable. This seems like motivated reasoning.
It fully explains the rise the world over.
I said there can be a small real component. It is generally too small to detect in explicit causal decomposition.
You have poor reading comprehension skills.
Everyone in many industrialized countries had the exact same incentives around the 1980s and 1990s?
Yet those same incentives didn't exist in all those different health systems and cultures in the 1960s and 70s?
The factors you've pointed out don't explain the global rise. Especially the sudden change in pace.
The rise isn't identical everywhere, so your first point is a non-point.
Before the DSM-III, autism was not commonly known and diagnosis was rare and idiosyncratic due to the extremely high standards for diagnosis. And yes, before the DSM-III, nowhere had diagnosis incentives.
You don't understand the background of this phenomenon even though you've had the chance to read about it.
It's not identical, but we've seen a similar increase in many countries at around the same time period (the UK, Canada, several European countries, Japan - studies provided in the first link.)
The DSM-III was published in 1980, yet the rates remained low in many places and only started increasing in the 1990s and 2000s.
And the causality isn't clear here at all. Was autism not commonly known in the past because of the high standards of diagnosis? Or was it not commonly known in the past because it was actually rare?
Edit: also see a systematic review and meta-analysis of over 100 studies on this subject- https://discovery.ucl.ac.uk/id/eprint/10178142/
The conclusion: "It evidenced that there has been a rise in ASD over time, that methodological differences cannot account for a significant amount of the variability between prevalence estimates and that changes in diagnostic criteria are not sufficient to explain the observed increase in ASD."
Thank you for writing this detailed post! Let me add two minor suggestions.
First, NIH needs to focus research dollars on the profound end of the autism spectrum and heavily scrutinize study proposals that fail to deliberately consider profundity. Kids with level 1 autism who are fine in a general education classroom just aren’t the same as level 3 kids who need a high-intensity special ed setting, but it’s much easier to recruit level 1 kids and make over broad claims about your results.
Second, all of these programs need a fast-track approval process for genetic diagnoses with autism as a secondary diagnosis. Kids with, say, Angelman Syndrome aren’t going to stop needing a high amount of services. Genetic screening these days is cheap enough that private insurance encourages it and provides fast-track approvals for kids with genetic disorders.
What's if ABA works for other disorders like mental retardation- the same as with Autism. Isn't it then just a question of resources?
If it works as well for mental retardation as for autism, that's news to me. But also, there's more to diagnostic substitution than just swapping for mental retardation. Autism gets swapped with tons of different disorders.
Like which ones? Where's the evidence for this?
Don't comment until you've done the reading the article explicitly says it expects you to have done.
https://www.cremieux.xyz/p/whats-the-deal-with-autism-rates