Autism in the U.S. has increased by about 25% since 2006 according to a new report issued by The Centers for Disease and Prevention (CDC). It has nearly doubled from the CDC report released in 2002. That means for every 88 children, 1 has autism or a related disorder.
The report notes that boys are almost five times more likely to have autism than girls. Currently, 1 in 54 boys have an autism spectrum disorder. The number of girls is 1 in 252.
"One thing the data tells us with certainty - there are many children and families who need help," CDC Director Thomas Frieden said at a press conference.
The spike in numbers begs the question; Are parents, teachers, pediatricians and general health care providers better able to diagnose the disorder - thus more cases are being reported, or are the number of new autism cases actually increasing?
When asked about this during the news conference, CDC's Frieden pointed out that "doctors have gotten better at diagnosing the condition and communities have gotten better at providing services, so I think we can say it is possible that the increase is the result of better detection."
Advocates for people with autism nevertheless seized on the new data to call for more research to identify the causes of autism-spectrum disorder and for more services for those affected by it.
"This is a national emergency and it's time for a national strategy," said Mark Roithmayr, president of the research and advocacy group Autism Speaks. He called for a "national training service corps" of therapists, caregivers, teachers and others who are trained to help children with autism.
"Inevitably when these statistics come out, the question is, what is driving the increase?" said Roithmayr. Better diagnoses, broader diagnostic criteria and higher awareness, he estimated, account for about half the reported increase.
The new analysis from the CDC comes from the Autism and Developmental Disabilities Monitoring Network, which currently operates at sites in 14 states.
To determine whether a child has autism or a related disorder, what CDC calls "clinician reviewers" examined the medical and school records of 337,093 eight-year-olds in those states in 2008 and conducted screenings. Children, whose records included either an explicit notation of autism-spectrum disorder or descriptions of behavior consistent with it, were counted as falling on the autism spectrum.
The prevalence of autism in the states monitored by CDC varied widely, from a high of one in 47 in Utah to one in 210 in Alabama. Experts said that variation likely reflected differences in awareness of the disorder among parents, teachers and even physicians, as well as differences in the availability of services, rather than any true "hot spots" of autism.
The National Institute of Neurological Disorders and Stroke defines autism spectrum disorder (ASD) as a range of complex neurodevelopment disorders, characterized by social impairments, communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior.
Although the disorder can be mild or severe, in general children with autism have difficulty communicating and making friends. Many find it painful to look other people in the eyes - which can impair their ability to understand what others are thinking and feeling.
There are no medical tests that can identify autism. Brain imaging, blood tests or other rigorously objective diagnostics cannot give a patient a verifiable result one way or the other. Instead, physicians determine whether someone fits the criteria laid out in the American Psychiatric Association's Diagnostic and Statistical Manual, or DSM. Someone must meet at least 8 out of 16 standards of criteria, including symptoms involving social interaction, communication, and repetitive or restricted behaviors and interests.
The manual has undergone significant changes over the years causing some to question whether the updated criteria may be the reason for the increased cases. Morton Ann Gernsbacher, a professor of psychology and autism researcher at the University of Wisconsin, Madison, and others have cited these changes to question the reality of the reported autism increase.
At this point in time, no one knows what actually causes autism. Some scientists believe that environmental factors may play a role. Scientists had long estimated that 90 percent of autism risk was genetic and 10 percent reflected environmental factors. But a 2011 study of twins by scientists at Stanford University concluded that genes account for 38 percent of autism risk and environmental factors 62 percent.
Exactly what those factors are, however, remains the subject of intense research, with two large studies funded by the National Institutes of Health examining everything from what the mother of a child with autism ate during her pregnancy to what cleaners were in the house and what pollutants were in the dust.
"There is not a clear front-runner" among possible environmental causes of autism, said Craig Newschaffer, chair of the Department of Epidemiology and Biostatistics at Drexel University School of Public Health and lead investigator of one of the NIH-sponsored studies.
There is, however, what he called "good evidence" that any environmental culprit is present during the second or third trimester, the peak of synapse formation. Scientists believe that faulty brain wiring underlies autism.
Other factors investigated were the use of anti-depressants by pregnant women, older women becoming pregnant, and the rise in pre-term and low-birth weight babies.
Even as experts disagree on whether the reported increase in the prevalence is real and what causes the disorder, there is a clear consensus that "the earlier a child is diagnosed the more he will benefit from interventions," Dr. Coleen Boyle, director of CDC's National Center on Birth Defects and Developmental Disabilities said during the news conference.
The American Academy of Pediatrics (AAP) recommends that children be screened for autism at 18 months and again at 24 months.
Children with autism generally have problems in three crucial areas of development — social interaction, language and behavior. But because autism symptoms vary greatly, two children with the same diagnosis may act quite differently and have strikingly different skills. In most cases, though, severe autism is marked by a complete inability to communicate or interact with other people.
Symptoms to look for include:
- Fails to respond to his or her name
- Has poor eye contact
- Appears not to hear you at times
- Resists cuddling and holding
- Appears unaware of others' feelings
- Seems to prefer playing alone — retreats into his or her "own world"
-Starts talking later than age 2, and has other developmental delays by 30 months
- Loses previously acquired ability to say words or sentences
- Doesn't make eye contact when making requests
- Speaks with an abnormal tone or rhythm — may use a singsong voice or robot-like speech
- Can't start a conversation or keep one going
- May repeat words or phrases verbatim, but doesn't understand how to use them
- Performs repetitive movements, such as rocking, spinning or hand-flapping
- Develops specific routines or rituals
- Becomes disturbed at the slightest change in routines or rituals
- Moves constantly
- May be fascinated by parts of an object, such as the spinning wheels of a toy car
- May be unusually sensitive to light, sound and touch and yet oblivious to pain.