Dispatch October 2009

Behind the Autism Statistics

The CDC now says that 1 in 100 Americans has autism. But is the epidemic real? It turns out that many children with other developmental problems are being given autism diagnoses just to get them state funding.

This week, the journal Pediatrics released new statistics compiled by the CDC on the prevalence of autism, boosting the rate from 1 in 150 to 1 in 100. It’s another staggering leap in an apparent epidemic—more than doubling the rate of children diagnosed with autism since 1996.  Indeed, over the past dozen years, autism has made sad, steady progress from obscure syndrome to seemingly ubiquitous developmental disorder.

In every state, our scary autism epidemic fuels walkathons, awareness events, and a proliferation of local chapters of national autism organizations. And across the country, concerned parents whose children aren’t keeping up or seem troublingly different, turn to medical professionals and early childhood educators for evaluation and help. The problems are real.

But what if the autism statistics are wrong?

In 1987, the Diagnostic and Statistic Manual of Mental Disorders (DSM) began broadening the definition of autism to include not only children for whom socialization is impossible, but also those with varying levels of ability to interact and function. What was once a devastating affliction known simply as “autism” evolved into a “spectrum” of disorders, encompassing everything from profound impairment to far milder challenges. Naturally, this more expansive definition of autism partly explains the exponential increase in diagnoses in recent years.

But many children whose symptoms significantly differ from classic autism—who belong only on the milder end of the autism spectrum, if they belong anywhere on the spectrum at all—are inaccurately ending up with serious autism diagnoses.

How does this happen? When doctors drop the a-bomb on a family, it helps to have an action-plan, answers, and ready resources at hand to reassure the frantic parents. Many states offer autism intervention services, but most don’t offer subsidized therapies for children who are falling off of the developmental ladder due to milder disorders—sometimes sensory, sometimes in motor planning or other areas. 

So parents whose kids’ challenges are less severe are often urged to accept a full-fledged autism diagnosis, as otherwise they would lose access to state-funded treatment, and might, down the line, end up ineligible for support services in public school.   The result is that the autism statistics grow and grow.

That’s Graham Linthorst’s story. At just seventeen months old, Graham became an autism statistic even though he didn’t have autism. It’s a tale that’s chillingly familiar to thousands of families traveling in the autism world with a misdiagnosis, and no map to the exit door.

Graham’s parents started to worry just before his 1½-year checkup.  He seemed to be losing language, acting spacey, and resisting play. He was assessed by the state of California and given a provisional diagnosis of autism. They were told he was in need of therapy, and handed a prescription for Applied Behavioral Analysis (ABA)—considered the gold standard therapy for children with autism.

Sounds good: state-funded screening and help. Except for one problem: Graham doesn’t have autism. He’s “autistic-like.” No matter, Erik and his wife Jennie were told, just go with the autism label—he needs help NOW.

But shortly after choosing a clinic and beginning therapy, Erik and Jennie Linthorst realized that while Graham was making some progress, the therapy didn’t seem to be addressing his biggest problems, which involved motor challenges and sensory issues, rather than the kinds of social impairments typical of autism.

Applied Behavioral Analysis focuses on repetitive commands and reinforcements to prompt typical developmental and social behavior. But Graham had only a few of the  idiosyncratic behaviors – like repetitively spinning wheels and walking on lines on the floor – that are characteristic of many children with classic autism. Most telling, he instinctively made eye contact, and was very interested in connecting socially, unlike most children with autism.

The Linthorsts decided to pay out of pocket and took him to a developmental pediatrician who made a sensory profile of Graham. She determined that Graham in fact has a milder syndrome that's not on the autism spectrum, called Sensory Processing Disorder—a diagnosis that doesn’t come with services. Keep the autism label anyway, she advised. Otherwise there would be no more state support for treatment. She also recommended trying another kind of therapy, one the Linthorsts would have to pay for themselves.

About six months down this twisted, poorly illuminated path, Erik started to make a documentary about their experience. The medical and educational establishments’ failure to provide straightforward diagnostic or therapeutic help for his child just didn’t seem right. It shouldn’t be happening to them, and it shouldn’t happen to anyone else. He started filming at Graham’s doctor’s appointments and therapy sessions.

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