Was I wrong about Autism?

Recent data published by the Centers for Disease Control indicate that one in every 88 American kids has Autism.  So, does this mean I’ve been wrong about the so-called Autism “epidemic” in this country?  No, I don’t think so.  Keep in mind, these new data indicate how many kids have an Autism-spectrum diagnosis.  They don’t indicate how many kids actually have the condition.  In other words, they don’t do anything to separate the invalid diagnoses from the valid ones.  If you’ve been a regular reader or viewer for a while, a lot of this will be familiar to you, but here’s the real story on Autism as I see it:

First of all, Autism is a real and serious condition, and I have sympathy for sufferers and their parents.  At the same time, I think that the prevalence of Autism among America’s kids is being greatly overstated by a rapidly-growing “Autism industry” — similar to the “ADHD industry” that’s been foisting unnecessary psych meds upon millions of kids for decades now.  As both a lawyer and a psychologist, I want to take on these “industries” because I think they hurt kids.  In my professional judgment, there’s simply no way that five or six million American kids have diseased brains that can’t focus attention (ADHD), and there’s no way that one out of every 88 American kids has a pervasive developmental disease (Autism).

It’s not that there’s been an Autism explosion in America, and it’s not that we clinicians have just gotten exponentially better at detecting Autism cases that went undetected in previous generations.  It’s that medical and mental-health professionals have been steadily expanding and loosening the definition of Autism to encompass kids who really just have minor (if any) developmental delays that they’ll typically grow out of within a few years.  Take diabetes for example:  As it is now, if your fasting plasma glucose level is consistently above 125 mg/dl, you may be considered diabetic, but if we steadily dropped that cutoff down to say 100 mg/dl, we’d steadily have a lot more diabetics.

Here are three reasons why I think this has happened:

1) Parents of mildly-delayed kids who don’t want to admit that their kids are just average kids, or who want a chemical shortcut around the hard parenting work that’s needed to help a mildly-delayed kid catch up, or who want to secure benefits and services for their kids, sometimes actually seek out a diagnosis,

2) As pharmaceutical companies have developed (or, more often, re-purposed) drugs to try to “treat” Autism, they’ve pushed the diagnosis, just as they’ve pushed the ADHD diagnosis, and

3) There’s been a lot of agenda-driven, activist-driven research promoting the idea that Autism’s a lot more common than I think it really is, and this research has been disseminated by individuals and organizations who have vested interests in getting more research dollars thrown at the problem (i.e. if you’re a researcher whose job is funded by tax and/or pharmaceutical dollars, and you’re studying 100 kids, and you’re motivated to “stretch” the Autism diagnostic criteria to fit as many of them as possible, then it’s really no big surprise that you might succeed once by the time you get to kid #88, even though I could probably examine that same kid the next day and disagree with you completely).

Even the American Psychiatric Association is onto this:  As it prepares the upcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the Association has announced that it’s narrowing the diagnostic criteria for Autism so that it’ll be harder to (ethically) diagnose the disorder (you know it’s bad if the Association’s actually trying to shrink the number of Americans who qualify for a psychiatric diagnosis – it usually seems to want to do the opposite, progressively expanding the diagnostic manual to Biblical proportions with each successive edition!).

If/when a narrower set of diagnostic criteria actually sees the light of day, you’ll hear sob stories in the media from the “Autism industry” and its beneficiaries (including some celebrities) about kids and parents who may no longer qualify for insurance and government benefits.  When you hear such stories, keep in mind that billions of insurance and tax dollars are being spent on services for kids who really don’t have any serious problems – that’s a powerful incentive for some parents, pharmaceutical companies, and clinicians to want the diagnosis to be liberally applied, valid or not.

In the meantime, here’s my bottom line on what I continue to believe to be the over-diagnosis of Autism:  It’s insidious, because when you have a bunch of basically-normal kids being raised as if they have a mental disorder — whether it’s ADHD or Autism — it’s not good for those kids (because it lowers people’s expectations of them, as well as their expectations of themselves, which can easily become a self-fulfilling prophecy), and it’s not good for the kids who really do have the disorder either, because it dilutes the pool of resources available to them.

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