The US is one of the countries with many children diagnosed on the spectrum. What are some possible reasons?
Autism is a neurodevelopmental disorder that affects the way people think, feel, and behave. There are many causes of autism, but one of the most common is genetics. It has been increasing in the US over time. Read more in detail here: what is autism.
Since epidemiologists and academics started monitoring diagnosis rates in 2000, autism rates have been rising in the United States.
There have been fears that autism is spreading like a “epidemic” (concerns usually based on misunderstanding and misinformation). However, the rise in positive autism diagnoses is primarily attributable to a greater understanding of what autism and neurodiversity are, as well as diagnostic criteria that reflect this new knowledge.
It’s vital to look at how professionals diagnose autism to understand how we know more than we did previously.
Autism and Its Diagnosis
Before a doctor can diagnose autism spectrum condition, they must depend on observation and contact with the patient. The Diagnostic and Statistical Manual of Mental Disorders provides the criteria for these interactions. They define autism as having delayed or nonexistent social communication and interaction norms, as well as restricted interests and repetitive activities.
Autism affects one out of every 44 children in the United States, with males four times more likely than girls to be diagnosed. The disparity between boys and girls prompted demands to rethink how youngsters are tested for autism, particularly to address health-care gender inequities. This knowledge influenced the way autism diagnoses and rates are assessed.
The 1 in 44 rate is based on health information collected from schools in specific counties by the Centers for Disease Control and Prevention (CDC). Every two years, skilled doctors look for any complaints of social issues or repetitive habits that might indicate autism. The results are then projected to encompass the full state of those counties based on demographics.
Increasing & Disparate Autism Rates
Since its implementation in 2000, this strategy has altered the rate at which pediatricians and experts diagnose autism, with rates continuing to grow.
The incidence was 1 in 150 when data were first analyzed two decades ago. The growing trend was identified not just in the United States, but all across the globe, according to researchers.
Despite the fact that this is now the recognized technique of assessing the rise in autism diagnoses, experts argue that in-person assessments and observations are still the best way to go. Children who are homeschooled or who live in distant places with inadequate record-keeping may also go unnoticed and misdiagnosed.
Autism rates, for example, range significantly from state to state. Autism is diagnosed in one out of every 93 children in Colorado, but one out of every 41 children in New Jersey (the highest in the country, according to local media). Natural factors, according to epidemiologists, are unlikely to account for that level of diversity. Instead, differing degrees of autism awareness and accessible treatment are more likely to exist in certain states.
Autism: An Overview
The rise in autism rates in the United States is attributed to more than just statistics. It’s also because of how we see autism spectrum disorder. The basic concept of autism has been developing since the diagnosis was originally published in 1943, and this has affected the changing rates of autism diagnoses.
For example, in 1966, experts assumed that just 1 in 2,500 children had autism since the disorder’s more subtle manifestations were unknown, and clinicians exclusively concentrated on individuals with the more severe forms of the spectrum. In fact, it wasn’t until decades later that the idea of autism being on a spectrum was proposed.
In 1987, a new version of the Diagnostic and Statistical Manual of Mental Disorders extended the autism criteria, requiring a child to satisfy 8 of the 16 criteria instead of the previous edition’s requirement of 6 out of 6. As a result of these developments, the incidence of autism diagnoses has risen to one in every 1,400 people. Since then, the rate has been steadily rising.
Special Education & Reclassification
Another watershed moment occurred in 1991, when the Department of Education approved special education services for autistic youngsters. This may have prompted parents to seek more assistance for their children if they believed that access to special education programs, which they would not have been qualified for earlier, was possible.
The addition of Asperger syndrome (AS) as a lesser type of autism spectrum disorder in the fourth version of the DSM, released in 1994, expanded the frontiers of autism knowledge even farther. The CDC’s statistical results are based on the DSM-criteria IV’s of autism. Autism, Asperger’s syndrome, and pervasive developmental disability (not otherwise specified) were combined into a single diagnosis in the DSM-5 edition. Autism supporters were outraged by the reclassification, which was backed up by several researchers.
However, unlike previous versions, the DSM-5 addressed the issue of autism spectrum disorder and attention deficit hyperactivity disorder being diagnosed simultaneously. Some persons with autism may have been misdiagnosed with attention deficit hyperactivity disorder as a result of this (ADHD).
The DSM-5 allows for many disorders to be diagnosed. Many children with developmental difficulties are being evaluated for autism on a regular basis. As a result, the likelihood of their being accurately identified rises, and the number of autism diagnoses in the United States rises.
The American Academy of Pediatrics advised that at normal physician visits, all children aged 18 to 24 months be tested for autism. It’s probable that this proposal resulted in a large number of youngsters being diagnosed with autism who would not have been diagnosed otherwise.
Demographics & Diagnoses
According to experts and studies, the primary reason for the rise in autism rates in the United States is that people are much more aware of the illness now than they were a generation or even a decade ago. Many persons with autism, whether diagnosed or undiagnosed, were committed to institutions as recently as the 1970s, essentially eliminating them from any type of care and from any autistic statistics.
Furthermore, parents who are aware of the signs of autism are significantly more likely to seek assistance than parents who are oblivious of the symptoms. People who live in (or near) cities and have access to health care and education are more likely to be knowledgeable enough about autism to seek treatment or assistance from a doctor. This might possibly be one of the reasons for the rise in diagnostic rates.
This also implies that school nurses and teachers are more likely to notice and properly document the hallmarks of autism, such as restricted interests, repetitive behaviors, and communication and social difficulties, in school and medical records.
The female demographic is one group that has had a significant role in the rise in autism prevalence in the United States. For a long time, it was considered that females could not “get” autism, owing to the socialization of girls to be quieter and less energetic than boys. Girls with autism were assumed to be behaving in conformity with the time’s gender conventions.
Autism Rates Have a Systemic Underrepresentation
In minority ethnic communities, access to health care decreases the prevalence of systemic misdiagnoses. Because minority communities have had less access to health care in the past, Hispanic and African American children have had lower rates of autism diagnoses. There has also been less access to autism education, which has led to the disproportionately lower rates.
Autism diagnoses have historically been higher among white children in America as a consequence of these issues, resulting in “wide underrepresentation” of autism in minority groups. Minority groups’ access to education and health care has enhanced the disorder’s detection.
This has led to the high incidence of autism diagnoses among Americans of all ages and socioeconomic backgrounds. Autism prevalence “is more likely to be greater in places with the greatest degree of [socioeconomic] hardship,” according to the PLOS One journal in 2015.
Autism Rates in Different Parts of the World
This is true not just in the United States, but around the globe.
Axios reported in 2018 that 4.57 million children under the age of five had autism, or one in every 138 children in every nation, based on the Lancet’s Global Burden of Disease research. The majority of them reside in underdeveloped or low-income nations, with one million in Sub-Saharan Africa and one million in South Asia. The Middle East, North Africa, and Central Asia have the highest incidence of childhood autism.
So much of the conversation on autism focuses on affluent countries like the United States, Canada, and Western Europe that it’s easy to forget that the majority of children with autism live in places with limited access to health care and education. The true number and rate of autism diagnoses throughout the globe is very certainly far greater than what is currently known.
In terms of worldwide numbers, India has 851,000 autistic children, making it the world’s biggest. China comes in second with 422,000 people. There are around 150,000 children with autism in the United States and Canada, and 140,000 in Western Europe.
Factors That Contribute
Does this imply that the incidence of autism in the United States has not increased? While we now know more about the condition and criteria have altered to reflect this new knowledge, there are other biological reasons that might be contributing to the rise.
Children born to older parents (particularly older men) have a greater chance of developing autism than children born to younger parents, according to research. Similarly, prematurely born infants may have an increased chance of being on the spectrum. However, medical improvements have resulted in a considerably greater survival percentage for prematurely delivered infants than ever before. Inadvertently, this may contribute to the rise in autism rates among youngsters in the United States.
Frequently Asked Questions
What is one reason for the increase in autism in the US?
A: That is a difficult question to answer. It only takes one reason for something to happen, but it doesnt mean that the reason in and of itself was what caused it. There are many different factors which contribute to the increase in autism rates across America, including more awareness about how autism can be present within your family history, socio-economic status (a higher socioeconomic class increases an individuals chance of having a child with Autism Spectrum Disorder), and other cultural changes like women being able to get abortions without fear of judgement
Why is the prevalence of ASD increasing?
A: The prevalence of ASD is constantly increasing due to the development and availability of technology.
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Janice is a Board Certified Behavior Analyst. She graduated from the University of British Columbia with a Bachelor of Arts in Psychology and Special Education. She also holds a Master of Science in Applied Behaviour Analysis (ABA) from Queen’s University, Belfast. She has worked with and case managed children and youth with autism and other intellectual and/or developmental disabilities in home and residential setting since 2013.