26 out of 1000 People Are Autistic: Chemicals? Better Diagnosis?
Earlier this year, New Jersey Senator Frank Lautenberg introduced the Safe Chemicals Act of 2011, which will require most chemicals to be “given a basic level of health and safety screening by the U.S. EPA and the information recorded in a publicly available database,” according to Environment News Service. Recommendations made by the National Science Academy in 2008 had called for an assessment of the effects of cumulative exposure to different chemicals on the brain. What is the effect of chemicals including BPA, mercury, phthalates and brominated flame retardants on expecting mothers and very young children?
In view of the marked increase in autism of the past decades, from 1 in 10,000 to (according to a study of children in South Korea published last month) 1 in 38 among 7 to 12 years old, surely there must be something – something in the environment — causing such a huge increase?
The 1 in 38 prevalence rate found by researchers from Yale University and George Washington University certainly raised a “collective gasp…from the autism community,” as filmmaker Todd Drezner writes in the Huffington Post. Drezner, who’s the parent of a child on the autism spectrum, interviews one of the study’s authors, anthropologist Roy Richard Grinker, about the results that say to some, we don’t just have an epidemic of autism — people have said that when the rate was 1 in 166 and 1 in 110 — we have a pandemic, an all-out outbreak, a plague. Read about global warming, the decrease in the food supply, climate change and other assaults on the environment by human-made chemicals and creation, and it seems too obvious — the increase in autism in today’s children has to be another effect of the toxic world we live in.
Grinker has written before about the rise in the autism rate in his 2007 book Unstrange Minds: Remapping the World of Autism. The book attracted its share of controversy because of his arguments that one reason for the higher rate is that we have better tools for estimating prevalence, for counting cases of autism. Our understanding of autism, of psychiatric disorders and intellectual disability, is far greater and has enabled us — professionals as well as parents — to identify autism for often and at an earlier age in a child. Another factor is culture: In the US, acceptance of racial, ethnic, sexual orientation and other differences has grown, so that there the stigma of saying one’s child is autistic, or that one is oneself, has greatly lessened (while still definitely remaining). Autism is simply “more common than we think,” as Grinker says.
Such arguments have been met with skepticism in some quarters, certainly among parents who are positive about an environmental agent as a cause, including Lise Huguenin, a mother of an autistic son who is quoted in the Environment News Service article. She holds a doctorate in environmental science/exposure measurement and assessment from Rutgers University and the University of Medicine and Dentistry of New Jersey. Chemicals and toxins are tangible agents that we can point to and global warming is certainly feeling all too real to me, anticipating — with the rest of the East Coast — record 99 degrees temperatures in early June.
One might think that people who think there’s a recent “epidemic of autism” would be welcoming the 1 in 38 study and asking about research on environmental toxins in South Korea.
However, 1 in 38 study suggests that it’s not that there’s necessarily some new upsurge in autism cases, but that we’re just figuring out how to count them. Under lead researcher Dr. Young-Shin Kim, a child psychiatrist and epidemiologist at the Yale Child Study Center, Grinker and a team of autism experts designed a study to measure the autism rate in the entire elementary school population of the Ilsan district in Goyang City:
That total population turned out to include 36,592 children in participating mainstream schools and 294 listed in Ilsan’s Disability Registry (the latter group was identified as having a high probability of having ASD). As a first step, all parents were asked to complete a preliminary 27-item questionnaire that assessed their children for possible symptoms of and behaviors associated with autism.
Then Grinker and the team did “extensive community outreach, educational sessions with teachers, interviews and focus groups” and “learned how to talk about autism in a way that didn’t frighten people away from our study,” especially in view of the stigma associate with autism in South Korea where mothers are more likely to have a child diagnosed with Reactive Attachment Disorder to reduce the shame brought onto a family, says the Los Angeles Times. The researchers took a great deal of care in designing and performing their study, as Drezner writes:
Ultimately, parents of 23,337 children completed the questionnaire. The team made extensive efforts to contact the parents of children who screened positive for ASD and to invite the children for multi-hour evaluations with the gold-standard diagnostic instruments, validated in the Korean language. Two clinical teams made final diagnoses, and each team included a Korean child psychiatrist trained in both Korea and the U.S. The final 2.64-percent prevalence estimate was made up of .75 percent from the high-probability group and 1.89 percent from regular schools. (The authors emphasize that their results have not been replicated, and certain factors may have caused them to overestimate or underestimate the prevalence rate.)
Grinker suggests that the surprisingly high percentage of children with ASD in mainstream classrooms may be partially explained by the culture of Korean schools. He notes, “The schools emphasize structure and routine within the classroom, learning by rote memory, and few transitions or alterations in daily schedules.” You couldn’t ask for a better classroom for an autistic child. Nevertheless, Grinker emphasizes, “The team would never have found these kids if they weren’t suffering, or didn’t have significant functional impairments.” Given the rigor of the study and the expertise of the team, it seems likely that these children were accurately diagnosed.
As Grinker points out, say the autism rate is 2.64 percent and people express shock; say it’s 26.4 per 1000 — so, out of about 1000 children about 26 are on the autism spectrum — and people say, “oh yeah.”
What might be the results if a study like the one about Ilsan school children were carried out? Is it believable that, for every 1000 people in your community, about 26 persons might be on the autism spectrum?
Should we rather be shocked that we used to think the prevalence rate of autism was so low?
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