Evidence against ASD "epidemic" - the great reclassification

Post Reply New Topic

Below is my collection of links to pages showing how the increase in childhood "autism" diagnoses is, in fact, not much greater than a corresponding decrease in the number of children whose primary diagnosis (for special ed purposes) was "intellectual disability" or "mental retardation":

Autism: Epidemic or Explosion? (And Why It Matters)
We have been here all along.
James Coplan MD
Making Sense of Autistic Spectrum Disorders
Posted Jul 12, 2016
https://www.psychologytoday.com/us/blog/making-sense-autistic-spectrum-disorders/201607/autism-epidemic-or-explosion-and-why-it-matters

Coplan - Making Sense of ASD Part 2
James Coplan, MD
January 14, 2014
http://www.drcoplan.com/media/LACE-02.pdf

Evidence against an “autism epidemic”
Orac
April 4, 2006
https://respectfulinsolence.com/2006/04/04/evidence-against-an-autism-epi/

Another reminder that there is no autism epidemic
Orac
January 25, 2017
https://respectfulinsolence.com/2017/01/25/another-reminder-that-there-is-no-autism-epidemic/

Increasing prevalence of autism is due, in part, to changing diagnoses
[Special ed stats: 2/3 of "autism" rise is "ID" decline]
by Sam Sholtis
Penn State News
July 21, 2015
https://news.psu.edu/story/363374/2015/07/21/research/increasing-prevalence-autism-due-part-changing-diagnoses?utm_source=newswire&utm_medium=email&utm_term=363760_HTML&utm_content=07-23-2015-17-35&utm_campaign=daily%2520newswire

The Contribution of Diagnostic Substitution to the Growing Administrative Prevalence of Autism in US Special Education
Paul T. Shattuck
Pediatrics
April 2006, VOLUME 117 / ISSUE 4
https://pediatrics.aappublications.org/content/117/4/1028.abstract?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

More Evidence Autism Rates Not Truly Increasing
Published by Steven Novella
Jan 24, 2017
https://theness.com/neurologicablog/index.php/more-evidence-autism-rates-not-truly-increasing/

Relevant academic journal articles:

Investigating Diagnostic Substitution and Autism Prevalence Trends
Craig J. Newschaffer
Pediatrics
April 2006, VOLUME 117 / ISSUE 4
https://pediatrics.aappublications.org/content/117/4/1436?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

Diagnostic Substitution and Changing Autism Prevalence
Paul T. Shattuck
Pediatrics
April 2006, VOLUME 117 / ISSUE 4
https://pediatrics.aappublications.org/content/117/4/1438

Evidence of a reduction over time in the behavioral severity of autistic disorder diagnoses
Andrew J.O. Whitehouse
Matthew N. Cooper
First published: 19 January 2017
https://doi.org/10.1002/aur.1740
https://onlinelibrary.wiley.com/doi/full/10.1002/aur.1740

Last edited by Mona Pereth on 10 Jun 2019, 5:13 pm, edited 1 time in total.

I totally agree that there is no "autism epidemic"---and there never has been one.

Now...the proof is in the pudding!

If the anti vaxxers have a theory I can have one. I have posted it a number of times before but there are always new members.

The anti-vaxxers and those looking at other environmental poisons are looking at the wrong environmental factors. IMHO we are a more autism unfriendly world than even 30 years ago in these ways.

There is more sensory stimulation.

Much more multitasking is required to function today.

In the days of old for certain jobs, it was expected the person would be in the corner doing his or her thing, nowadays the key job requirements for most jobs even programmers listed are people/networking skills/team player. When I entered the workforce I was often told the boss and employee do not have to like each other as long as they act professionally towered each other and "this is a place of business, not a social club"

The issues below effect everybody but are worse for people with innate social issues
Devices instead of face to face inhibit learning social skills.
Helicopter parenting and bulldozer parenting inhibit learning to be independent.

Today peoples days are completely planned out and busy inhibiting independence, learning one's strengths and weakness. This can cause multitasking, sensory and burnout problems.

Thus I believe there are a whole lot of people who might have functioned with difficulty that can't be functional today which is the definition of "disorder".

The above is not meant to negate the important role of the expansion of diagnostic criteria.

Agreed, these are big problems in today's world.


Yep. Even worse: The "open office" fad. Even a lot of NT's hate the lack of privacy.


But now there seems to be more emphasis on fitting in to company culture. That's a BIG problem for autistic people.


Some other, longer-term relevant trends:

Back in the old days, when most people lived and worked on farms or in some other business that was engaged in by the entire family, most people learned their social skills primarily at home, via explicit teaching from their parents and/or older siblings.

With the advent of the industrial revolution and then the advent of mass education, kids are now expected to pick up most of their social skills on their own, on the school playground. This was fine for NT kids, but not so fine for the kids who would now be labeled "autistic."

An even further development in this direction happened in the 1970's. Until then, most kids -- or at least most middle-class kids -- still spent most of their time in early childhood at home with their mothers. But then, as more and more middle-class mothers went into the out-of-the-home workforce, either by choice or because they had to, even their small children now spent most of their time in child care centers or preschool, getting even less one-on-one attention from their parents.

This too turned out to be fine for most NT kids, but not for the kids now labeled "autistic." I think it's no coincidence that Asperger's Syndrome started to be recognized (in the English-speaking world) about a decade after the mass movement of mothers into the workforce was mostly complete.

(And, no, I DON'T think the solution is for women to go back into the kitchen. But we do need society as a whole to become much better at educating autistic kids. This will require the input of autistic people.)

I'm not an expert but hasn't changes in diagnostic criteria between DSMIII and DSMIV accounted for the rise in people being picked up for diagnosis, particularly more females picked up than in the past.

Of course that -- and greater public awareness of autism -- are the biggest parts of the picture, as I documented in my original post in this thread. But there are other possibly relevant issues too.


The issue of under-diagnosis of women and girls became a big deal in the literature about ten years ago, long after the DSMIV was published. But, yes, that's another factor expanding the number of people who get diagnosed.

There is an interesting divergence in ASD diagnosis between developing and OECD countries. One interesting link is the gut-diet-biome relationship whereby an increase in hygiene results in first world babies being overrun with particular bacteria that secrete neurotoxins. Whereas developing coutnries the normal flora of the gut is much more diverse due to greater exposure to bugs + consumption of food that is more likely spoiled/fermented.

Another interesting one is the difference in electronic screen devices correlated with rate of diagnosis, traditional societies have limited access to TVs and whether cathode ray exposure from the 1960s might be a potential environmental trigger.

Lots to speculate about

Also the recognition that adults in general can be autistic. Although changing, the childhood schizophrenia roots of the autism diagnosis still predominates in research and attention.

good thread.
wonder how long it will take to percolate out into the general populace as "news"...

Probably a lot fewer psychotherapists per capita in developing countries, much less psychotherapists qualified to diagnose ASD? As long as that's the case, there's probably not much basis for concluding anything about relative prevalence.

Most workplaces seem like social clubs these days.

I admit that I didn't read any of those articles but I ask you with all due respect , if there is no autism epidemic , then why does it often take years to get a diagnosis ? My grandson was diagnosed recently as ASD and ADHD but the therapist chose to go with the ADHD rather than the ASD because the diagnosis was " sticky " , whatever that means . To me , it means that school resources for special needs are overwhelmed and that by going with the ADHD , they can just give him a pill instead of improving his environment ? Can you imagine how much it would cost to build a sensory friendly school environment ? I wish they would though , everyone would benefit . I can still hear those loud bells in my school that signaled the end of class , why couldn't they use a sophisticated chime sounds like they do in VIP airport lounges ?

Costs too much for schools...

Not just autistic people, but 1/6 of people in general, have sensory issues.

First, I want to point out that IDEA (Individuals with Disabilities Education Act) became law in 1975. It was the first special education law. It required schools to evaluate students who were suspected to have a disability at no cost. It established the right for children to receive special education services from schools at no cost. I have an education background (and history too) so I'd be happy to go into more detail, but those are the basics.

Before disabilities were more accepted (and this includes people who wouldn't be able to cope well in public, including school environments) people were kept at home, away from the outside world. Thanks to IDEA, kids could go to school and it was reasonably assumed they'd learn something, so more of them did. Special education classes were typically also separated from the general education classroom, but it was one step. "Inclusion" policies in schools are a fairly new phenomenon, so visibility feels even more stark these days than it used to.

I think kids who had ASD either weren't recognized as having a disability (they're just "weird," they're just "shy," they just "like to play alone," they just "need to get over it," etc.) or they weren't really included in things and weren't categorized as having a disability; that doesn't mean outcomes were better because it was overlooked. In fact, it was probably worse. It was just "bad behavior" to many parents and teachers that thought punishment would correct. I was recently doing a literature review for a research proposal about ASD and foster care. Kids with ASD are at an increased risk of abuse that's higher than NT kids. And if it's still this way today, that means it most likely has not changed, it just wasn't studied. Of course, not all or most kids with ASD end up in foster care, this is just one way to look at mistreatment/abuse data.

ASD is co-morbid with other diagnoses, such as ADHD, and is misdiagnosed in people as schizophrenia or bipolar disorder. It could be that people with ASD were either misdiagnosed or were diagnosed with one disorder but ASD was overlooked.

I can see where you are coming from, but the notion that ASD is caused in part by attachment issues is not evidence-based and harmful. Daycares don't produce worse-off children, and not all parents are aware of evidence-based practices. In fact, I'd say most people who are parents don't, even if they did stay home with their kids. It's true that one-on-one time has significant benefits for children. But we also know from Vygotsky that social interaction is essential for learning - yes, even kids with ASD. Social isolation doesn't make people with ASD more successful. In fact, having social supports and therapy is highly important for better outcomes. ABA therapy, in particular, is the go-to in early childhood and supports better social outcomes (although I know this is controversial in our community -- I will say from some of the posts I've read, I think it is misunderstood; I've been in sessions with clinicians who are using it, and I was at every session with my son who has ASD was doing it and I have ASD too). I'd be happy to relay my own perspective as well). I don't think ABA therapy was as popular of a thing as it is today until... maybe the 90s? I can't quite recall.

I appreciate your viewpoint but I think it can be misconstrued easily and I really wanted to stress that parenting and daycares have absolutely nothing to do with ASD.

My point was not that "ASD is caused in part by attachment issues." My point is that that early 1900's transition to mass public education, and then the 1970's transition from home-based childcare to daycares and pre-schools, may have made made many autistic children more noticeable -- not that it caused their autism in the first place.

In the old days, social skills were more explicitly taught, by parents and older siblings, rather than being something kids were expected to learn primarily on their own, from experience with each other. That's one possible reason why, in the old days, autistic kids didn't stick out quite as much as they do in today's world.

Autistic people have probably existed for as long as there have been humans on this Earth. That being the case, how come no one seems to have noticed autism at all until the early-to-mid 1900's, and how come it didn't begin to be widely noticed until the 1980's or 1990's or so, and how come there are still hordes of undiagnosed adults? To me, this implies that there are many facets of the modern world that have made autistic people stick out more now than in past eras.

Another such facet of the modern world, besides the one discussed above, is the many sensory triggers (like fluorescent lights) that simply did not exist in past eras.