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The Autism Generation

Pedro

Well-Known Member
The Autism Generation
Allen Frances
2011-07-19

SAN DIEGO ? Not long ago, autism was among the rarest of disorders, afflicting only one child in every 2,000-5,000. This changed dramatically with the publication in 1994 of DSM IV (the manual of psychiatric diagnosis widely used around the world). Soon, rates exploded to about 1 per 100. And a large study in South Korea recently reported a further jump to 1 in 38 ? an astounding 3% of the general population was labeled autistic. What is causing this epidemic and where are we headed?

The natural reaction to any plague is panic. Parents are now fearful that every delay in speech or socialization presages autism. Childless couples decide to avoid having kids. Parents with autistic children are desolate and desperate to determine its cause.

The British physician Andrew Wakefield?s vaccine theory became wildly popular among parents, many of whom began to withhold vaccination (thus subjecting their own and other children to the risk of entirely preventable, and sometimes serious, illnesses). Vaccination seemed a plausible cause because of the fortuitous correlation between getting shots and the onset of symptoms. Wakefield?s work has now been thoroughly discredited as incorrect and dishonest science. But fear of autism is so great, and the reactions to it so irrational, that in some circles Wakefield continues to be revered as a false prophet.

Other factors must be behind the sharp rise in the diagnosis. Before DSM IV, autism was among the most narrowly and clearly defined of disorders. Symptoms had to begin before age three and comprised a striking and unmistakable combination of severe language deficits, inability to form social relationships, and a preoccupation with a very narrow set of stereotyped behaviors. In preparing DSM IV, we decided to add a new category describing a milder (and therefore much more difficult to define and distinguish) form of autism, called Asperger's Disorder. This seemed necessary because some (still quite rare) children presented with more or less normal language development, but with grave social and behavioral difficulties. We knew that Asperger?s would likely triple the rate of autistic disorders to about 1 per 500-1,000, but this doesn't explain the new rate of 1 per 38.

A second possible explanation for the explosion in autism is that previously missed cases are now being more accurately diagnosed. This is probably a factor, but again only a minor one.

Perhaps, then, an environmental toxin is causing an epidemic outbreak of autism. This has been the most popular theory, but it, too, is a small factor, at best. There has been no sudden environmental change since 1994 to account for an explosion in rates. This doesn't entirely disprove an environmental vector, but it does make the odds quite remote ? especially since there is a far more plausible explanation.

The most likely cause of the autism epidemic is that autism has become fashionable ? a popular fad diagnosis. Once rare and unmistakable, the term is now used loosely to describe people who do not really satisfy the narrow criteria intended for it by DSM IV. Autism now casts a wide net, catching much milder problems that previously went undiagnosed altogether or were given other labels. Autism is no longer seen as an extremely disabling condition, and many creative and normally eccentric people have discovered their inner autistic self.

This dramatic swing from under- to overdiagnosis has been fueled by widespread publicity, Internet support and advocacy groups, and the fact that expensive school services are provided only for those who have received the diagnosis. The Korean study, for example, was financed by an autism advocacy group, which could barely contain its enthusiasm at the high rates that were reported.

The Korean study paid no attention to the bias that haunts all epidemiological studies, which always overestimate pathology rates by including as disorder even very mild presentations that do not have clinical significance. It is entirely plausible that 3% of the population may have some smidgen of autism, but it is entirely implausible that so many would have symptoms severe enough to qualify as an autistic disorder. Reported rates should be regarded as an upper limit, not as a true reflection of the rate of actual mental disorder.

Human nature, neurological illness, and psychiatric disorder all change very slowly, if at all. Environmental toxins do not usually just pop out of nowhere to make a condition 100 times more common than it was less than 20 years before. A more plausible scenario is that DSM IV gave autism purchase by introducing a milder form that is close to the extremely populous boundary of normality. Then autism took flight on the wings of definitional diffusion, internet contagion, financial incentive, and na?ve interpretation of epidemiological results.

The autism ?epidemic? is set to spread further starting in May 2013, when the next revision of the diagnostic manual (DSM 5) will be published. The DSM 5 definition of an ?autistic spectrum? will cast an even wider net, capturing many people now considered to be normal or to have another disorder. Their symptoms will not have changed ? just the label.

Allen Frances MD was Chair of the DSM IV Task Force.

Copyright: Project Syndicate, 2011.
Project Syndicate - the highest quality op-ed ( opinion-editorial ) articles and commentaries

Source/Original article: The Autism Generation - Allen Frances - Project Syndicate
 
Then what used to be autism was... what?

I keep hearing that the term "Asperger's Syndrome" is going to be completely dropped from the DSM-V and that people with those characteristics will go under the general umbrella category of "high-functioning autism." I'm not sure if that's a good idea or not.
 
My friends with AS say no. As for me, though, I just wonder what will autism turn out to be in future.
 
I keep hearing that the term "Asperger's Syndrome" is going to be completely dropped from the DSM-V and that people with those characteristics will go under the general umbrella category of "high-functioning autism." I'm not sure if that's a good idea or not.

Er...it's my understanding HFA has some marked differences from Aspberger's, though, or am I wrong?
 
High-functioning autism - Wikipedia, the free encyclopedia

High-functioning autism (HFA) is an informal term applied to autistic people who are deemed to be "higher functioning" than other autistic people, by one or more metrics. There is no consensus as to the definition. HFA is not yet a recognised diagnosis in the DSM-IV-TR or the ICD-10.

The amount of overlap between HFA and Asperger syndrome is disputed. Some researchers argue that the two are distinct diagnostic entities, others argue that they are indistinguishable.
 
Interesting insight.

So is DSM-V our greatest enemy or is it something else.? Something else that becos of the blindfolding of people's eyes that people have not discovered as one of the causes of autism.

Think about it, in parts of the ocean, the concentration of plastics to plankton is 40:1. Doesn't take much IQ to figure out that something will go wrong?
 
If you're really into environmental stuff, then we're all better off advocating for the environment and not just for the plights of autistic people. But since we still do not really know the causes, what else can we do other than to say 'or Aspies by Aspies'
 
We will never know if we just blind ourselves to one factor in the autism or ADHD epidemism. Vaccines, Environmental toxins, DSM-V all of these account for the autism epidemism.

I think Scientists need to think on the ethical side to their discoveries and somethings might be big impacts on people in ways you can never imagine. For example the Human genome project has taken into consideration the possibility of genetic discrimination. I think the DSM- V has had to rethink their plans.etc as this can turn millions of people into low-self esteemed people or ostracized individuals especially in Asia.
 
And not to forget a few more million people in the Western Hemisphere.

We don't need another name for a disease or a disability, we need hope.
 
We all need to believe in hope. Not some diagnosis that is going to turn me from a human into a freak becos of some changes.

Can you imagine one day in this movie, you replace Apes with Aspies and autistics?
 
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Isn't there already friction between the autistic people and the NTs, for differences in building a better world?
 
Yeah Imagine now you tell them that autism is on the rise. The NTs will do anything to solve the problem.

Read between the lines "solve the problem", it will mean that NTs will do anything... anything to remove us.
 
Tigris, I know a few governments who just simply let autistic people die on their own. They should be exposed on media outlets, instead of being hidden beneath the carpet. And autistic people should better learn to master the means of media...
 
That is one way to help us but ironically it can be one way to kill us as well. Like this article said, DSM-V's revision will result in more people getting diagnosed and labelled. If getting label = getting support for all, I say I am fine with it. But if getting diagnosed= getting targeted for bullying or social rejection, discrimination, genocide, I say DSM-V is not helping but doing more harm than good.

To put this in context, the DSM-V is not that mainstream becos the media does not cover it that much. But this will not be the case in the near future. For history references, it is the labelled that gets targeted first. Sorry to be realistic lah. This has been seen in history countless times.

Anyone else has any other comments?
 
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But that's because Aspies are not born to master media. Media involves the strong discipline to both expose and hide certain ideas to our advantages. If we can't, either we learn or lament in life that we don't get opportunities.

That aside, my biggest question is, what was autism before autism?
 

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