Increase In Autism Diagnosis Research Articles

ECHO Autism Washington: Autism Diagnostic Evaluations in Primary Care.

ECHO (Extensions for Community Healthcare Outcomes) Autism is a telementoring learning model to increase community capacity for autism-related health care. Seventy-seven pediatric providers (mostly primary care, seeing exclusively Medicaid patient populations) enrolled in 1 year of ECHO Autism Washington. Analysis of self-report surveys showed a significant increase in autism diagnoses made by ECHO providers after 1 year, F(1, 65) = 7.52, P = .008. Providers who attended more sessions reported making more diagnoses, F(2, 613.26), P = .045. Of note, autism diagnoses were not externally validated. The total number of reported barriers reduced, F(2, 61) = 13.5), P < .001, and confidence ratings increased F(2, 60) = 24.21, P < .001. The average number of diagnostic referrals from ECHO providers to the state's largest autism specialty clinic significantly reduced, t(43) = 4.23, P < .001, with significantly fewer diagnostic referrals made during and after ECHO training compared with a comparison group of 28 non-ECHO providers, t(58.77) = -3.36, P < .001. Overall, 1 year of ECHO Autism Washington participation led to significant changes in autism diagnostic practices.

Literature Review on High-functioning Autistic Employees

This literature review aims to contribute to the field of autism and employment. It will analyse bibliographic data on peer-reviewed research on the benefits and challenges of a neurodiverse workforce. Similarly, it will examine the experiences of high-functioning autistic people in the workplace. Despite reports in popular media on the benefits of a neurodiverse workplace, including better innovation and company performance – there is very little academic research to support these claims. Of the limited existing literature, there are very few articles in business and management journals. This review gathers empirical evidence to test such claims. The research is based on high-functioning autistic people (verbal, with average or above IQ). Autism will be referred to as Autism Spectrum Disorder (ASD) from here on, which includes Asperger syndrome under the criteria of the DSM-5. Data from peer-reviewed research articles on high-functioning autism, employment and adults in the Social Sciences Citation Index were analysed to gauge the current trends in publication and citation. This database was chosen to limit the medical literature, which is extensive and an entirely different field. The data indicates that research on the experiences autistic employees, and their employers, up to recent years has been an understudied field. Based on the analysis used for this study, research and interest in this field began to emerge in publications in 2005. This review identified high-functioning autism as an increasingly important factor to consider in designing hiring and recruitment processes. It is also a significant consideration in conflict-resolution, communication and the training and support areas of management. Considering the steep increase in autism diagnoses over the past 30 years, coupled with the supports made available to autistic people up to third-level education; a more neurodivergent, educated talent pool is emerging which will change the way managers approach and manage diversity in the workplace.

A Novel Movement Assessment for Autism: The WES Scale

Arguably the greatest responsibility of a coach is to help an athlete move better. From sports to strength and conditioning training, the athlete is constantly in motion and utilizing basic movement patterns to achieve an array of goals. With this in mind the ability of a coach to work with athletes of different autism profiles is necessary to provide a comprehensive curriculum. Of importance, the rise of autism diagnoses has dramatically increased with a 787% increase in diagnoses from 1998 to 2018. With this increase in autism diagnoses the need for coaching capacity to meet this influx is vital, with responsibility falling on coaching educators. Offering coaches continuing education to efficiently work with this population can help to promote inclusive sports and gym settings. Among these new curricula being developed, adaptive coaches have created a novel movement assessment that can be used with autistic athletes. The WES Scale movement assessment was originally created by autistic coach educator Julien Pineau. This curriculum serves to produce well-rounded coaches and gym environments where movement development can be shared with autistic athlete profiles through precise movement assessment.

A New Direction for Autism Research

Autism prevalence seems to have increased from 0.62 percent in 2012 to 1.85% in 2020. During this same 8-year period there has been no reported increase in prevalence for any other disorders listed in the DSM-5. This threefold increase in autism diagnoses coincides with the 2013 creation of the autism spectrum disorder (ASD) umbrella category under which are now included a range of confusingly dissimilar conditions. It thus appears that two-thirds of those who have been diagnosed with ASD may not be autistic. If so, then recent research into the genetic causes and risks for autism may be questionable. There is no way of knowing if the correlations researchers are finding are to autism or to other conditions.

Designing Beyond the Americans With Disabilities Act (ADA): Creating an Autism-Friendly Vocational Center.

The Americans with Disabilities Act (ADA) has been effective in establishing building standards that create accessible spaces for people with physical impairments. These guidelines have not addressed the needs of people with mental, emotional, and/or developmental disabilities. With the increase in autism diagnosis, designers/architects need to expand their planning to include more universal solutions. The purpose is to demonstrate ways of designing beyond ADA to address needs of people with autism spectrum disorder (ASD). To design effectively, designers/architects must identify sensory issues that influence these children in establishing a regulatory state enabling effective interaction with neurotypical peers. Design is also important for teachers, therapists, and parents of children with ASD to enable more successful interactions. If the environment is overstimulating for a child with ASD, then a parent/caregiver/therapist will struggle to achieve their goals. Mostafa recommended seven design criteria known as ASPECTSS™: Acoustics, Spatial sequencing, Escape spaces, Compartmentalization, Transition spaces, Sensory zoning, and Safety, when designing for people with ASD. These classifications lay the groundwork for the established guidelines. As designers/architects, we have a responsibility to create inclusive environments. To help, the authors highlighted a vocational center showing one plan that meets ADA guidelines and another that illustrates additional environmental features addressing the needs of people with ASD. These criteria originated from evidence-based solutions derived from a literature review and personal interview. These recommendations demonstrate that sensitivity to the needs of people with autism creates a solution that is better for all people.

Secular changes in the symptom level of clinically diagnosed autism.

The prevalence of autism has been reported to have increased worldwide. A decrease over time in the number of autism symptoms required for a clinical autism diagnosis would partly help explain this increase. This study aimed to determine whether the symptom level of clinically diagnosed autism cases below age 13 had changed over time. Parents of Swedish 9-year old twins (n=28,118) participated in a telephone survey, in which symptoms and dysfunction/suffering related to neurodevelopmental disorders [including autism, but also attention-deficit/hyperactivity disorder (ADHD), Developmental Coordination Disorder (DCD), and Learning Disabilities (LD)] in their children were assessed over a 10-year period. Survey data was merged with the National Patient Register containing clinically registered autism diagnoses (n=271). In individuals who had been clinically diagnosed with autism before the age of 13, the symptom score for autism decreased on average 30% over more than a decade in birth cohorts 1992-2002. There was an average decrease of 50% in the autism symptom score from 2004 to 2014 in individuals who were diagnosed with autism at ages 7-12, but there was no decrease in those diagnosed at ages 0-6. Over time, considerably fewer autism symptoms seemed to be required for a clinical diagnosis of autism, at least for those diagnosed after the preschool years. The findings add support for the notion that the observed increase in autism diagnoses is, at least partly, the by-product of changes in clinical practice, and flag up the need for working in agreement with best practice guidelines.

Pre-Service Teachers’ Knowledge, Misconceptions and Gaps About Autism Spectrum Disorder

The inclusive education framework and the increase in autism diagnoses have led to an overwhelming challenge for pre-service teachers who need to be qualified to teach all children. To test the quality of their training, the main purpose of this study was to compare 866 pre-service teachers’ knowledge, misconceptions, and gaps about autism in their first and final year at university, using the Autism Knowledge Questionnaire. The results show that fourth-year students obtained higher levels of knowledge and fewer gaps than the first-year students, although they also had more misconceptions. Special education specialists obtained significantly more knowledge and fewer misconceptions than the general education pre-service teachers. Specific training and experience had a significant influence on the knowledge and gaps, but it had no influence on the number of misconceptions. These results suggest that university preparation in autism spectrum disorder (ASD) might not adequately train all future teachers.

Autism and gender: from refrigerator mothers to computer geeks

The reasons behind the increase in autism diagnoses have become hotly contested in the media as well as within the medical, scholarly, and autistic communities. Jordynn Jack suggests the proliferating number of discussions point to autism as a rhetorical phenomenon that engenders attempts to persuade through arguments, appeals to emotions, and representational strategies. In Autism and Gender: From Refrigerator Mothers to Computer Geeks, Jack focuses on the ways gender influences popular discussion and understanding of autism's causes and effects. She identifies gendered theories like the refrigerator theory, for example, which blames emotionally distant mothers for autism, and the extreme male brain theory, which links autism to the modes of systematic thinking found in male computer geeks. Jack's analysis reveals how people employ such highly gendered theories to craft rhetorical narratives around stock characters--fix-it dads, heroic mother warriors rescuing children from autism--that advocate for ends beyond the story itself while also allowing the storyteller to gain authority, understand the disorder, and take part in debates. Autism and Gender reveals the ways we build narratives around controversial topics while offering new insights into the ways rhetorical inquiry can and does contribute to conversations about gender and disability.

RISING AUTISM PREVALENCE: REAL OR DISPLACING OTHER MENTAL DISORDERS? EVIDENCE FROM DEMAND FOR AUXILIARY HEALTHCARE WORKERS IN CALIFORNIA

AbstractAutism is a development disorder that has increased in prevalence from 0.5 to 14.7 per 1,000 children over 1970–2010. Using annual wages and provider counts from the American Community Survey and information from 21 regional development centers in California, we estimate the labor demand for auxiliary health providers. We focus on this subset of providers because, unlike physicians and psychologists who can diagnose autism, these workers cannot induce their own demand. If the incidence of autism is increasing independently of other mental disorders, then the demand for auxiliary health providers should increase, leading to higher wages and labor supply. Otherwise, the increase in autism diagnosis is merely displacing other mental disorders. We find that a 100% increase in autism cases increases the wages of auxiliary health workers over non‐autism health occupations by 8–11% and the number of providers by 9–14%. Furthermore, we find that one of every three new autism diagnoses is merely supplanting mental retardation diagnoses, but does not displace other mental disorders. These estimates suggest that at least part of the increase in autism diagnoses, about 50–65%, reflects an increase in the true prevalence of the disorder. (JEL L11, J2, J3)

Authors' Response to: Cohort effects explain the increase in autism diagnosis among children born from 1992 to 2003 in California

Authors' Response to: Cohort effects explain the increase in autism diagnosis among children born from 1992 to 2003 in California

Cohort effects explain the increase in autism diagnosis among children born from 1992 to 2003 in California

Cohort effects explain the increase in autism diagnosis among children born from 1992 to 2003 in California

Cohort effects explain the increase in autism diagnosis among children born from 1992 to 2003 in California

The incidence and prevalence of autism have dramatically increased over the last 20 years. Decomposition of autism incidence rates into age, period and cohort effects disentangle underlying domains of causal factors linked to time trends. We estimate an age-period-cohort effect model for autism diagnostic incidence overall and by level of functioning. Data are drawn from sequential cohorts of all 6 501 262 individuals born in California from 1992 to 2003. Autism diagnoses from 1994 to 2005 were ascertained from the California Department of Development Services Client Development and Evaluation Report. Compared with those born in 1992, each successively younger cohort has significantly higher odds of an autism diagnosis than the previous cohort, controlling for age and period effects. For example, individuals born in 2003 have 16.6 times the odds of an autism diagnosis compared with those born in 1992 [95% confidence interval (CI) 7.8-35.3]. The cohort effect observed in these data is stronger for high than for low-functioning children with an autism diagnosis. Autism incidence in California exhibits a robust and linear positive cohort effect that is stronger among high-functioning children with an autism diagnosis. This finding indicates that the primary drivers of the increases in autism diagnoses must be factors that: (i) have increased linearly year-to-year; (ii) aggregate in birth cohorts; and (iii) are stronger among children with higher levels of functioning.

Risk as Social Context: Immigration Policy and Autism in California1

Motivated by the dramatic increase in autism diagnoses in recent years, research into risk factors has uncovered substantial variation in autism prevalence by race/ethnicity, SES, and geography. Less studied is the connection between autism diagnosis rates and the social and political context. In this article, we link the temporal pattern of autism diagnosis for Hispanic children in California to state and federal anti-immigrant policy, particularly ballot initiative Proposition 187, limiting access to public services for undocumented immigrants and their families. Using a population-level dataset of 1992-2003 California births linked to 1992-2006 autism case records, we show that the effects of state and federal policies toward immigrants are visible in the rise and fall of autism risk over time. The common epidemiological practice of estimating risk on pooled samples is thereby shown to obscure patterns and mis-estimate effect sizes. Finally, we illustrate how spatial variation in Hispanic autism rates reflects differential vulnerability to these policies. This study reveals not only the spillover effects of immigration policy on children's health, but also the hazards of treating individual attributes like ethnicity as risk factors without regard to the social and political environments that give them salience.

Sorting out the spinning of autism: heavy metals and the question of incidence.

The reasons for the rise in autism prevalence are a subject of heated professional debate. Featuring a critical appraisal of some research used to question whether rising levels of autism are related to environmental exposure to toxins (Soden et al. 2007, Barbaresi et al. 2009, Thompson et al. 2007) we aim to evaluate the actual state of scientific knowledge. In addition, we surveyed the empirical research on the topic of autism and heavy metal toxins. In our opinion empirical investigations are finding support for a link with heavy metal toxins. The various causes that have led to the increase in autism diagnosis are likely multi-faceted, and understanding the causes is one of the most important health topics today. We argue that scientific research does not support rejecting the link between the neurodevelopmental disorder of autism and toxic exposures.

Independent and dependent contributions of advanced maternal and paternal ages to autism risk.

Reports on autism and parental age have yielded conflicting results on whether mothers, fathers, or both, contribute to increased risk. We analyzed restricted strata of parental age in a 10-year California birth cohort to determine the independent or dependent effect from each parent. Autism cases from California Department of Developmental Services records were linked to State birth files (1990-1999). Only singleton births with complete data on parental age and education were included (n=4,947,935, cases=12,159). In multivariate logistic regression models, advancing maternal age increased risk for autism monotonically regardless of the paternal age. Compared with mothers 25-29 years of age, the adjusted odds ratio (aOR) for mothers 40+ years was 1.51 (95% CI: 1.35-1.70), or compared with mothers <25 years of age, aOR=1.77 (95% CI, 1.56-2.00). In contrast, autism risk was associated with advancing paternal age primarily among mothers <30: aOR=1.59 (95% CI, 1.37-1.85) comparing fathers 40+ vs. 25-29 years of age. However, among mothers >30, the aOR was 1.13 (95% CI, 1.01-1.27) for fathers 40+ vs. 25-29 years of age, almost identical to the aOR for fathers <25 years. Based on the first examination of heterogeneity in parental age effects, it appears that women's risk for delivering a child who develops autism increases throughout their reproductive years whereas father's age confers increased risk for autism when mothers are <30, but has little effect when mothers are past age 30. We also calculated that the recent trend towards delayed childbearing contributed approximately a 4.6% increase in autism diagnoses in California over the decade.

Autism, Through a Social Lens

Since the early 1990s the United States has seen a 10-fold increase in autism diagnoses. In 2007, 1 in 150 children were diagnosed with it, according to the Centers for Disease Control.

The Frequency of Polymorphisms affecting Lead and Mercury Toxicity among Children with Autism

Individual risk of developmental neurotoxicity with exposure to environmentally relevant levels of lead and mercury is likely to be determined by genetic susceptibility factors as well as additive interactions with other environmental pollutants, cumulative dose, and the developmental stage of exposure. The apparent increase in autism diagnosis over the last 15 years has enhanced interest in the possibility that an environmental trigger may be required to uncover the genetic liability in some cases of autism. The exquisite sensitivity of the developing brain and immune system to very low levels of lead and mercury give this hypothesis biologic plausibility. Delta aminolevulinic acid dehydratase (ALAD) and coproporphyin oxidase (CPOX) are two enzymes inhibited by low levels of lead and mercury, respectively. Common polymorphisms in these genes have been associated with elevated blood levels of lead and mercury and could potentially increase vulnerability to prenatal and/or postnatal developmental neurotoxicity. To explore this possibility, the frequency of the ALAD2 variant and variants in CPOX-4 and CPOX-5 were evaluated in 450 autistic children and 251 unaffected controls. A significant increase in the frequency of the ALAD2 allele was observed; however, contrary to our hypothesis, the frequency of both CPOX variants was significantly lower among the autistic children. Both lead and mercury induce oxidative stress by depleting the major intracellular antioxidant, glutathione. Among 242 autistic children with the variant ALAD2 allele, significant decreases in plasma glutathione and in the glutathione redox ratio were observed. These results suggest that children with autism who inherit the ALAD2 allele with lower glutathione levels may be at increased risk for lead toxicity during prenatal and postnatal neurodevelopment.

More evidence to reassure physicians and parents about vaccination.

It has been suggested that vaccination, particularly with the mumps, measles, and rubella (MMR) vaccine, may be related to the development of autism. One of the arguments for a possible association is that the prevalence of autism has been increasing at the same time that infant vaccination coverage has increased. Although the prevalence of autism and similar disorders appears to have increased recently, whether this is an actual increase or due to increased recognition and changes in diagnostic criteria is not clear. The clinical evidence in support of an association derives from a report of 12 patients with inflammatory bowel conditions and regressive developmental disorders, mostly autism.1 The authors' speculation that MMR vaccine may cause autism through a persistent bowel infection has generated much interest because it provides a possible biologic mechanism for a causal association. A subsequent epidemiologic study in the United Kingdom, however, did not find an association between MMR vaccination and the onset of autism.2 Several different analyses were performed, all of which showed no association. One of the findings of the study was that although autism prevalence had increased in the study population, the increase started before the introduction of routine MMR vaccination in Britain in 1987, and there was not an abrupt increase in prevalence after the vaccine's introduction. The interpretation of this finding, however, has been debated. The study by Kaye et al provides evidence that the autism trends in the United Kingdom are not related to MMR vaccination. The study was a time trend analysis of a large database of general medical practices in the United Kingdom and compared diagnoses of autism with coverage of MMR vaccine. There was a striking 7-fold increase in the incidence of newly diagnosed cases of autism from 1988 to 1999. Among boys, the incidence of autism increased 4-fold for those born in the years from 1988 to 1993. For the same birth cohorts, the coverage of MMR vaccine was stable at more than 95%. Thus, there was no correlation between the large increase in autism diagnoses and MMR coverage. Studies in Sweden and California have also not found any temporal correlations between MMR coverage and autism trends.3,4 The epidemiologic findings are consistent with current understanding of the pathogenesis of autism, which has a strong genetic component and whose neurologic defects probably occur early in embryonic development. It seems unlikely that a vaccine that is given after birth could cause autism. A few cases of autism may have onset after 1 year of age (regressive autism), but the 1 epidemiologic study that included such cases did not find an association with MMR vaccination.2 Currently, the weight of the available epidemiologic and related evidence does not support a causal association between MMR vaccine—or any other vaccine or vaccine constituent—and autism. The possibility of an idiosyncratic reaction in certain susceptible persons cannot be ruled out, but such occurrences would have to be rare and have not been detectable in large epidemiologic studies. In general, parents and physicians should be reassured that MMR vaccine does not cause autism.