Reply to Is ASD a useful label or is it we don’t know we will lump it under an umbrella term?

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Reply to "Is ASD a useful label or is it we don’t know we will lump it under an umbrella term?"

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[quote=Anonymous][quote=Anonymous]

Re: Diagnostic substitution. It's real and accounts for a lot of what is going on with the autism label. It's driven, as so many things are, by money in large part. Many states mandate services if you get an autism diagnosis, to there's a whole industry now tailored to get that diagnosis and providing the services the state will pay for. Have many friends doing this now.

And here's an article detailing how intellectually disability has dropped in almost an exact inverse relationship to how ASD has climbed:

https://www.wsj.com/articles/diagnostic-substitution-drives-autism-spike-1442425517

Here's info from about 12 years ago, marking the same trend in schools, the other labels dwindle while the ASD label climbs:

RESULTS. The average administrative prevalence of autism among children increased from 0.6 to 3.1 per 1000 from 1994 to 2003. By 2003, only 17 states had a special education prevalence of autism that was within the range of recent epidemiological estimates. During the same period, the prevalence of mental retardation and learning disabilities declined by 2.8 and 8.3 per 1000, respectively. Higher autism prevalence was significantly associated with corresponding declines in the prevalence of mental retardation and learning disabilities. The declining prevalence of mental retardation and learning disabilities from 1994 to 2003 represented a significant downward deflection in their preexisting trajectories of prevalence from 1984 to 1993. California was one of a handful of states that did not clearly follow this pattern.

And fyi: It was later found California wasn't including their language kids, which is why their numbers weren't the same as other states.

[/quote]
The data is absolutely correct, but there are a few problems with that.  First of all, Asperger's syndrome (now ASD, level 1) was not recognized at all until the early 80s, and did not make into the DSM until 1994. Many of these kids were mislabeled as mentally retarded or childhood schizhoprenia even when they had normal IQs.  So of course there was big jump in ASD after 1994 and a decline in intellectual disability.  Second, autism was not added as a category in IDEA until 1990, so pre-1990 school data is useless and we see a gradual rise in school autism after 1990, and decline in other diagnoses.  Third, there are in fact many children who have both intellectual disabilities and autism, but IDEA forces schools to pick a primary category, so after 1990, children with both could go either way, but the school had to pick.  Fourth, many states started requiring autism coverage in the late 2000's, early 2010's but we see rising autism rates going back to the 1990/1994 changes in definitions. Because the trend line goes so far back, it's more likely the states were responding to rising autism rates than causing it.

So even if there are few cases where borderline kids are called ASD to get services, the vast majority of the diagnostic substitution we are seeing are real cases that simply went unrecognized or were misdiagnosed prior the early 90s.  [/quote]

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