What's behind the "significant increase" in autism?

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The prevalence of child autism in the United States is higher than previously estimated, revealed a new report released today by the Centers for Disease Control and Prevention (CDC).

The estimates were combined from 11 communities within Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin.

Autism rates varied widely across the communities that are part of the prevalence monitoring network with a high of 1 in 34 in New Jersey compared to a low of 1 in 77 in Arkansas, but experts said this is likely due at least in part to record keeping differences. This marks a 15 percent increase from the most recent report two years ago, and the highest prevalence since the CDC began tracking ASD in 2000. "And these are diverse communities so that we can look at autism prevalence and characteristics in a number of different groups defined by race/ethnicity or by socioeconomic status".

White children are diagnosed with autism more often than black or Hispanic children, but the gap has closed dramatically.

"There's no such thing as an autism number, there's no test that you run, so this is clinicians applying their judgment to who is impaired by this condition", said Dr. John Constantino of Washington University, one of the authors of the report. The researchers said it's not clear whether autism rates in the two counties are higher than they are nationally, or whether local efforts to diagnose and treat autism are more robust than national efforts. That's up from one in 68 children identified with autism in 2016. Many doctors may be reluctant to jump to an autism diagnosis in a younger child, because they are "trying to be cautious and not alarmist", Hazlett said. The disorder is reportedly becoming more prevalent amongst minority children. This is nearly certainly not because something is affecting kids in New Jersey, said Zaharodny. "They were diagnosed around the time that they were three to four years old", Fletcher said.

Frazier agreed that diagnostic changes and increasing awareness have contributed to the increase in autism diagnoses.

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"Over time, the estimate might be influenced (downward) by a diminishing number of persons who meet the DSM-5 diagnostic criteria for [autism spectrum disorder] based exclusively on a previous Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnosis, such as autistic disorder, [pervasive developmental disorder not otherwise specified] or Asperger disorder, and influenced (upward) by professionals aligning their clinical descriptions with the DSM-5 criteria", they added.

He noted that the male to female ratio decreased in the new report. "We have data to suggest that the ratio is probably closer to 2- or 3-to-1 as opposed to 4-to-1". "We've also got to push on services, because look at the numbers".

"I would have hoped that we could have, by now, identified some of the real factors at play", he said.

"Parents can track their child's development and act early if there is a concern", Stuart Shapira, MD, PhD, associate director for science at CDC's National Center on Birth Defects and Developmental Disabilities, added in a press release. "Communities are doing a better job of identifying children and connecting them to services". It's more likely the better services, record-keeping and monitoring in New Jersey is finding more of the cases.

Shapira cited the CDC's Learn the Signs.

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