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Cover Story
Survey from CDC reveals a high number of autism cases in the USA in 8-years old children, besides a major increase compared to previous survey.
by Paiva Junior
The numbers are alarming. Else this was not for the credibility of the Center of Disease Control and Prevention (CDC), in the United States, the survey could be doubted. But that was not the case. To state that in the USA there is an average of one per 110 children age 8 has an autism spectrum disorder , this is, at least, alarming. And those were did in 2006.
As it is more common in boys, it presents even more alarming numbers (one per 110 individuals), whereas girls have lower risk (one per 315) – the ratio is one girl per 4 to 5 boys. The research mentions children being born with autism, what suggests that there may be an error on an ASD (autism spectrum disorder) diagnosis so premature (or suspicion). However, to tell you the truth, CDC was careful to analyze 8-years old children, to reduce, as much as possible, misdiagnosis, or mix-up with other syndromes. At age 2, however, most autistic babies show slight but visible signals (see article by Dr. Walter Camargos on this issue).
As if the alarming rate of 1% of children on the autism spectrum weren't enough, an average increase of 57% (between 27% and 95%) has been confirmed, compared to previous ones dated of 2002. Many institutions have already mentioned autism as the largest outbreak in the planet and each survey has confirmed that.
Science has not discovered yet what causes autism. Genetic inheritance and environmental trigger (see controversy between vaccines and autism on this issue) are hypothesis under study, but there is no conclusive and definite result.
2002 Numbers
CDC previous statistics was a result of 2002 survey, using same methodology and same target (10 communities participated in it). The result was an average of one per 150, 8-years old children. During disclosure in 2007, CDC director, at that time, Dr. Julie Gerberding, assessed: "Our expectations are getting better and more consistent, however, we are still unable to confirm whether is a real increase of autism cases or changes resulted from performing better studies", she said officially. On 2006 survey, results showed from one per 80 to one per 240, presenting an average of one per 110. Those studies are a national estimate, but confirm that the syndrome and global development disorders are more common today than decades ago (see article by Dr. Schwartzman on this issue).
Outbreak
Can we consider it an autism outbreak in the world? An improvement of diagnosis cannot be discarded, but, definitely, there is not a single factor that explains, without doubts, this increase in the numbers (see article by Psychologist Sabrina Ribeiro, on this page).
The increase from one per 2.500 children in the 90’s, to the alarming number of one per 110 switches on the red light to area experts. In the world, according to the Unites Nations, there are more than 70 million autistic people, impacting the way those individuals communicate and interact. In the United Kingdom, there are studies pointing out to one autistic child per 58, as per study from University of Cambridge – that previously pointed out one per 100. It is important to remind that autism also strikes all ethnic groups, social classes and geographic areas.
UN creates World Autism Awareness Day
To alert people about such a serious issue, UN (United Nations) created in 2008 World Autism Awareness Day, celebrated on April 2nd, and declared April as autism month in the planet. For 2010, UN Secretary-General, Ban Ki-moon, highlighted the importance of social inclusion. “Let us remember that each of us can take on that responsibility. Let us join persons with autism, their families and their advocates in a community of voices for greater awareness and understanding”, he said, when addressing his annual message, also mentioning autism complexity that demands more research. Several monuments and larger constructions around the world had turned its lights blue (color defined as autism symbol) to show favorable reply to the Awareness Day, such as the Empire State building, in New York (USA), and CN Tower, in Toronto (Canada). A speech from the President of the United States, on the 2nd, reminded us about this important date: “We have made great strides, but the challenges and barriers still remain for individuals on the autism spectrum and their loved ones. That is why my Administration has expanded investments in autism research, detection, and innovative treatments – from early intervention for children and coordinated family services to improved support for adults”. Barack Obama also said: “With each new policy that breaks these barriers, and with each attitude that is reshaped, we approached a world free from discriminations where all can achieve their fullest potential”.
Brazilian Reality
In Brazil there are no statistics about the syndrome, just an estimate dated of 2007: when our country had around 190 million people, there were approximately one million autism cases, as per Autism Project, from the Psychiatry Institution of Hospital das Clínicas, from São Paulo University (USP), consequently, one per 190 inhabitants (please note the word “inhabitants”, very different from the American statistics that stated “8-year old children”) – still an alarming number, but just an estimate.
We must alert, above all, government authorities, in order to create health policies for autism treatment and diagnosis, besides supporting and investing in researches on autism. Just suspicion and early diagnosis and, therefore, early intervention, can offer a better quality of life and perspectives to autistic individuals; as well as collecting data on the country to have an idea about how many cases there actually are in Brazil… and change this reality!
To create a national integrated system to provide care for autistic people may place in our country on the first line in the battle against autism, such as a bill already under Senate appreciation, elaborated by different entities bound to the cause. If such law is approved, that would be the first one around the world to prioritize autism and consider it as public health event in the country; thus putting together a record, capacitating health professionals, creating specialized medical care centers, and including autistic people on the disabled groups. This project has Congressman Paulo Paim (PT-RS) as main negotiator, who addressed Senate, April 5th, 2010, reminding Autism Awareness Day: “Senate will do its best to discuss such as an important matter in the Human Rights Committee (CDH). We are elaborating an agenda to discuss – if necessary, in other states -, in audience, the proposal already submitted to CDH. I have been talking to several entities bound to the cause and they all agree that we lack public policies to address the problem and investment in research to have an accurate early diagnosis”, said Paim.
There still isn’t a consensus among health authority to classify autism rates as outbreak – some are favorable, others still cautious. A fact, however, is certain: these numbers indicate that autism is more common than cancer in children, diabetes and AIDS. At least, we should pay attention to the matter.
EXTRA CONTENT
Autism outbreak?
by Sabrina Ribeiro
The first epidemiological research on autism was carried out by Lotter in 1966, in the United Kingdom. On this study he reported that there were 4,5 per 10.000 children from 8 to 10 years old (Lotter, 1966).
Since Lotter, dozens of studies have been conducted; and most recent studies have found out that there are around 10 per 10.000 individuals on autism spectrum; and up to 60 per 10.000 on TIDs - pervasive developmental disorders - (Charman, 2002; Fombonne, 2002 Wing and Potter, 2002).
Changes in autism rates have been discussed frequently. Recently, there has been crossing people’s mind the idea of an autism outbreak. One of those ideas was the usage of vaccines, i.e., MMR vaccine: Measles, Mumps and Rubella that may cause autism. This idea was spread and there was a major drop in vaccination, causing reappearance of eradicated diseases. Many studies were carried out and there was no evidence that there was a link between vaccines and autism. The studies did pointed out significant changes on autism concept and the methodology used to find new cases as responsible for this increase (Fombonne, 2002). The principal causes for this increase are:
1) Adoption of a wider concept: there has been a development on the terminology and a wider concept on autism spectrum disorder (Wing and Gould, 1979), considering as a spectrum of conditions that forms a triad of impairments varying in severity and demonstration (Charman, 2002). Because of that, a diagnosis criterion has expanded and a larger number of people can be diagnosed on the spectrum.
2) More awareness from physicians and community on autism manifestation: awareness has increased among professionals and educational services as well as increasingly acceptance on the fact that autism can co-exist with other conditions (Charman, 2002; Rutter, 2004; Williams and cols, 2006).
3) Better diagnosis of cases without mental retardation: with a wider autism concept and the understanding that some of its behavioral characteristics may be present – even if all criteria for the diagnosis are not met –, autism affects, very often, individuals that present a normal intellectual development, yet with impaired social cognitive deficits. As a result, there has been an increase about autism and TID diagnosis in individuals without mental retardation and without severe language impairment.
4) Improvement of care services for those individuals: since first findings in the 60’s, there has been an increase in educational and therapeutic services for children with TIDs and a government and professional awareness on the increase of the number of cases. Service quality and quantity for young people with autism still lesser than ideal, but much better and more disclosed than before. As a result, health and educational professionals are more aware of TIDs, as well as public in general. Because of that, it’s possible for children, today, have a better clinical evaluation and have their problems linked to TID symptoms. (Wing and Potter, 2002;Rutter, 2004).
5) Increase of epidemiological studies: with the increase of population epidemiological studies and the usage of standard methodology for diagnosis investigation, such as screening questionnaires, there have been contributions to diagnose cases that were not identified via clinical samples. The studies from the Reference Centers depend a lot on the capabilities of the professionals to recognize the cases and refer to the doctor. It’s very hard to evaluate the entire population on these studies, so that, there is a tendency to depend on indications. The ideal would be to carry out the research at each house, evaluating every individual who may be on the spectrum. Unfortunately, this research model is very expensive, and could only be performed in small population, and that might not be a true representation of the population. It is important to mention that the increase on autism prevalence numbers implies that more individuals have been diagnosed on the spectrum. Consequently, it does not imply that autism cases have been increasing (Klin, 2006).
Conclusion
Prevalence variations may create etiological hypothesis for autism, and this is vital to understand it. Accurate estimates for autism prevalence can be valuable for diagnosis and intervention service planning. Planning and condition may improve health and education professional’s awareness on autism and other serious development disorders. Epidemiological data indicate that TGD (Global Development Disorder) prevalence, today, reach 1% of the population, and an average of 1 per 70 8-year old boys. Compared to original estimate (4 per 10.000) made forty years ago, rates are by far higher than what was expected. This increase has been occurring since 60’s and it is due to, largely, a combination of factors, including improvement on diagnosis evaluation and adoption of a wider concept of autism. Despite the attempts on linking vaccines to autism, there was no evidence to confirm this hypothesis.
In Brazil this kind of epidemiological data is still sparse (Teixeira and cols, 2010). Scientific researches on autism and TIDs are extremely important for a better understanding of symptoms and related factors, especially in under development countries, where data are extremely sparse.
Sabrina Helena Bandini Ribeiro is psychologist and has also written about ABA on this issue.
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