Samantha Migliore

AP Language & Composition

Mr. Wise
January 22nd, 2017

Understanding America’s Autism Upsurge

An in depth investigation at whether the rise comes from improved diagnose, increased
awareness, - or something else.

America’s Autism Crisis:

In the 1970’s, about one in every 2,000 children was considered autistic. Today, a staggering 1
out of every 68 American children fall somewhere on the autism spectrum. It has been estimated
that between the years 2000 and 2010, the number of children with autism has more than tripled
in size (Cornwall). While autism rates are undoubtedly up, is autism really on the rise? This
spike in diagnoses has not only generated extreme concern, but also heavy controversy about
whether or not it is truly possible for the number of children being born with autism to increase
so dramatically in such a short period of time. While the causes of autism are still unknown,
America’s recent spike in autism diagnoses are most likely accredited to the extensive diagnostic
changes implemented within the past decade and a greater awareness surrounding the condition.
While many believe that constantly evolving environmental factors play a large role, the
evidence supporting these hypotheses is still unclear.

History Of Autism:

As of 2017, autism is typically described as a wide range of neurological conditions. Autistic

people typically lack communication skills, possess impaired social ability, and are prone to
repetitive patterns of behavior. However, autism is an incredibly diverse condition that was not
always categorized as such. Beginning in the late 1800’s autism was simply described a form of
mental retardation. However, soon after, autism became known as symptom of schizophrenia. In
the 1940’s Leo Kanner, an American physician and Hans Asperger, an Austrian pediatrician,
concluded that while an autism diagnosis still included childhood schizophrenia, to be

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considered autistic, a child must also possess obsessive habits and exhibit forms of social
isolation. This was course a radical discovery for the time, as Kanner’s rhetoric became the
formal definition of autism for the next 20 years. In the 1950’s it became commonplace to
believe that autism was a direct effect of a “cold” parenting style, especial if the child's mother
was exhibiting aloof tendencies. This theory, however, was disproved in 1964 by Bernard
Rimland, a psychologist who proved that the upsurge of biological evidence invalidated any
previous claims (Laidler). In the 1970’s autism was finally understood as a biological disorder
stemming from a child's brain development.

Eventually, research led experts to the paramount revelation that autism and childhood
schizophrenia were two completely separate disorders. This distinction was not formally added
into the Diagnostic and Statistical Manual of Mental Disorders until 1980. Just a decade later, the
definition of autism changed once again to include asperger's syndrome, a condition in which a
person's social skills are severely impacted. The latest addition to the American Psychiatric
Association’s definition of autism occured in 2013. It now folds all the previous subcategories of
autism like aspergers into one umbrella diagnosis. Autism is now a varying spectrum and a
person's specific diagnosis is defined by two categories: impaired social skills and restricted and
repetitive behaviors (DSM-5).

Descriptive Changes:

The most influential factor behind America's recent spike in autism diagnoses is undoubtedly the
drastic changes its definition has gone through. In 1994, around the same time that the last
change to autism’s definition was made, it was estimated that 66 out of every 10,000 children
were autistic. However, the most recent statistics, polled in 2014, show that rates have risen to 1
in every 68 children (David). In 2013, when experts decided to finally combine all subcategories
of the condition into one umbrella diagnosis, children with impaired social skills, and restricted
or repetitive behaviors now found themselves to be considered autistic (Zylstra). Before these
changes were implemented, these children were solely seen as developmentally disabled or
intellectually incompetent. Prior to the 1940’s, autism did not exist as it was not seen as a valid
condition until Kanner coined the term in 1943. Therefore, autism's official prevalence was zero.
Today, we know this to be false. Of course there were people living with autism, however, they
were simply seen as insane and not disabled. Kanner even stated that with the release of his
autism definition he immediately noticed that “almost overnight, the country seemed to be
populated by a multitude of autistic children,” a trend that became noticeable in other countries,
too (Willingham). While there is a correlation between the rising rates of autism diagnoses and
the short time frame in which these diagnoses were given, it can not be determined that the
relationship is due to an actual increase of autism prevalence among a population.

Diagnostic Substitution:

Alongside the expanding changes that the American Psychiatric Association has made to the
definition of autism, diagnostic substitution can also be attributed to a large part of today's
modern autism prevalence. Diagnostic substitution is the phenomenon in which a person’s
diagnosis of a specific condition replaces another one, causing an apparent decrease in the rate of
the first condition and an apparent increase in the rate of the second. For example, in 1980, when
autism and schizophrenia were officially distinguished from one another, the number of
schizophrenic children decreased while the number of autistic children increased. Still, the
amount of disabled children remained exactly the same. The category in which each of their
conditions fell was the only thing to adjust. In one 2009 study, Marissa King, a Professor of
Organizational Behavior at Yale concluded that 26.4% of the increased autism caseload in
California was a direct effect of diagnostic substitution. She accredits as much as one third of the
expanded autism population to changes in diagnostic criteria. The same study has also found that
that “in years in which the criteria for diagnosing autism changed, it was more likely that an
individual would obtain their diagnosis through diagnostic change.” Basically, most of the
children who have recently been given an autism diagnosis have only been diagnosed because
the American Psychiatric Association’s most recent definition of autism has broadened enough
to allow them to. Overall, it is clear that because of the official definition change, more children
are not being born with autism, but rather are finally being validated with the current diagnosis.

In Demand Diagnosis:

Many have also also stated that an autism diagnosis is not simply attaching itself to more people,
more people are now seeking out diagnoses themselves. As autism becomes more socially
acceptable, it has basically taken the place of what was previously referred to as a common
learning disability or simple mental retardation. Since the government supplies extra
opportunities and additional services to parents of autistic children, more parents have a greater
incentive to get their children diagnosed with autism specifically. These parents are now able to
secure services that would otherwise be unavailable to their children if they just had a simple
“learning disability” (Zylstra).

Diagnostic Tools:

The flexibility of the diagnostic tools used to diagnose children with autism spectrum disorder
are constantly changing, which in turn causes the number of autism diagnoses in America to
constantly fluctuate as well. This can be evident by a recent study at UCLA. Researchers
examined and then re-examined a population of 489 children who were living in Utah in the
1980’s. In the early 1990’s these researchers identified that 108 kids in the population were fit to
receive a diagnosis of “intellectually disabled” but not autistic. However, when these
investigators studied the same test group of 108 children a decade later and applied todays
autism diagnosis criteria they found that 64 out of the 108 seemingly “mentally challenged”
people would now be considered autistic today (Willingham). These people did not simply
develop autism over a decade, as autism is a condition in which you must be born with. The only
factor that changed from the 1980’s to the 1990’s was the official definition of autism. This
broadened up the spectrum of autism and allowed more people to categorize themselves as such.
The ways in which doctors detect and diagnose autism have become far clearer. The official
definition of autism is now at a relatively stable point. It covers a wide variety of conditions,
from mental disabilities to asperger syndrome. Thanks to these crucial changes, more cases are
finally being identified and diagnosed, leading to the spike in autism diagnosis that America has
witnessed in the past decade.

Increased Awareness:

Furthermore, a diagnostic change is not the only definite reason behind America's sharp increase
in autism diagnoses. As awareness surrounding autism increases, better methods to detect it
emerge within the medical community. This increased awareness has been proven to have a
direct increase on rates of autism across the United States. For example, in previous years, the
process of diagnosing a person with autism was not as demanding or regulated as it is today. But
in 2006, the American Academy of Pediatrics began recommending that all children be
mandatorily screened for autism before they reach two years of age. These screenings are sure to
lead to even more diagnosis which would have otherwise slipped under the radar (Wright).
Today, doctors must perform a two part developmental screening and then a comprehensive
diagnostic evaluation, in which a 25 point regulated checklist is utilized and other specialists are
referred to diagnose a single child with autism (Hepburn). Because doctors and researchers have
gained so much more knowledge about autism, its causes, and the symptoms that come alongside
it, earlier detection in children is now possible. Being able to detect this condition at earlier ages
encourages more doctors to actively search for it in all their young patients. Their searches have
not gone unnoticed, as they have resulted in an increased rate of autism prevalence across the
country. In one article published to the Journal of Family Practice, Robert G. Zylstra, a Clinical
Social Worker Specialist in Tennessee stated that “The Checklist for Autism in Toddlers and
subsequent modification were among the earliest and most effective screening tools, appropriate
for use in children as young as 16 months old”. These regulated checklists ensure that every
child receives the same diagnoses, anticipating greater accuracy. Yet, the rates of autism
prevalence vary from state to state. For example, New Jersey has the highest reported prevalence
of autism as 1 out of every 41 children are considered autistic there. This is not coincidental
since New Jersey is known for providing extensive services to people with autism. After all,
New Jersey is home to America's top elementary school for children on the autistic spectrum.
This in contrast to large rural areas such as Alabama, which has one of the lowest rates of autism
prevalence. (Willingham). On average, in Alabama, only 1 in every 175 children currently have
an autism diagnosis. This does not mean that more autistic children are being born in New
Jersey, but rather the increased awareness surrounding the condition in New Jersey has led to the
discovery of more children who are living with it. In Alabama, awareness about autism is low,
and even doctors are not educated on the topic in the same manner that doctors from New Jersey
are. This lack of awareness and knowledge has allowed more autism diagnoses to slip through
the cracks. Ultimately, proving once again, that an increase in autism awareness directly inflates
any given region's prevalence of the condition.

Genetics Changes Debunked:

Since this staggering increase in diagnosis can not simply be caused by one factor, many have
theorized that a large reason behind America's recent autism spike is a change in the genetic
makeup of human beings. For example, Michael Gertner of Albert Einstein College of Medicine,
states that FMRP and TSC are just two of the newly discovered autism-related genes that have
been researched in the past recent years. However, this theory is automatically eliminated since
human genes cannot transform that quickly on such a large scale (Falco). While the possibility of
genetic mutation has been proven impossible, it is entirely plausible that autism connoisseurs are
looking too deep into the issue. The answer lies on the surface, in plain sight. The broadening of
autisms definition simply caused more people to be considered autistic. New members of the
autistic community were always autistic, as they were born with the condition. The only
difference is that now, they are finally being recognized as such.

Environmental Factors:

Nonetheless, many still believe that a child is more likely to develop autism spectrum disorder if
certain environmental factors, such as various substances in the atmosphere or the level of
prenatal care given to the unborn baby, are taken into account. As dangerous chemicals in our
atmosphere, including pesticides and metallic-based pollutants, become more prevalent, the
likelihood that expectant mothers in these environments will birth children with autism spectrum
disorder increase as well. For starters, pregnant mothers who inhale more pesticides than their
clean air inhaling counterparts increase their chances of delivering a child with autism
dramatically. One study by Autism Speaks found that “living within a mile of pesticide
applications at any time during pregnancy was associated with a 60% increased risk that a child
would develop autism” (Autism Speaks). Another study, conducted by Kristen Lyall, an
Assistant Professor at Drexel University’ Modifiable Risk Factors Program, found that the more
air pollution a pregnant mother inhales, the greater her risk of birthing a child with autism
becomes. Similarly, elevated levels of nitrogen dioxide and monoxide also lead to a higher risk
of autism spectrum disorder during pregnancy (Lyall). As time goes on, it is obvious that the
health of the environment is rapidly deteriorating. In heavily populated areas like California, a
whopping eight out of ten people live in areas with an unhealthy level of pollution in the air
(Ortiz). This increase in pollution could be what is causing the apparent spike in autism
diagnosis. However, while environmental effects certainly have been proven to cause autism, we
cannot be entirely sure that they are responsible for the recent spike in diagnoses. Even so, for
these toxins to affect pregnant mothers and their unborn children so intensely in such a small
amount of time is extremely unlikely. This is similar to how human genes cannot drastically
transform on such a large scale in such a short amount of time. Overall, there has not been
enough data collected on the possible increase of pregnant mothers living in heavily polluted
areas to arrive at such a firm conclusion. Because of the lack of evidence, this claim is simply a
far stretched hypotheses, which is more than likely to result in an untrue outcome.

Prenatal Care:

Finally, the level of consideration infused into a woman's prenatal care routine has a direct
impact on her child's likelihood of developing autism. For instance, studies have proven that
when taken regularly, prenatal vitamins have been shown to decrease the chances that a child
will be born with autism spectrum disorder. One study conducted by a team of researchers at
Johns Hopkins University found that “mothers who said they took prenatal multivitamins three
to five times per week were much less likely to be told that their child was on the autism
spectrum compared with mothers who did not take the vitamins. Those who used them in the
first trimester were 67% less likely to have a child with autism” (Kaplan). Another study,
conducted in 2014, concluded that the consumption of prenatal vitamin supplements near the
time of conception yielded a 40% reduction in risk for autism spectrum disorder (Lyall). It is
exceedingly clear that women who take prenatal vitamins during their pregnancies are less likely
to birth children with autism than those who don't take any sort of vitamin. While deciding not to
take prenatal vitamins during ones pregnancy might negatively impact the child in the long run,
these vitamins, or lack thereof, are not the reason behind America's autism crisis. To illustrate,
last year, prenatal vitamins racked in $399 million dollars alone. According to a 2012 Market
Report, the use of prenatal vitamins has been fairly stable between 2008 and 2011 (Rosenberg).
If these supplements are responsible for the prevention of autism in unborn children, and the use
of them is stable across America, then it would make no logical sense as to why has autism
continues to increase in prevalence. Therefore, while the use of prenatal vitamins does correlate
with the prevention of autism, they are not the most influential reason behind America's recent
upsurge in diagnoses.

Final Conclusions:

The staggering upsurge in autism diagnoses that America has seen over the past two decades is
undeniable. Controversy, concern, and fear will always surround complex conditions such as
autism. However, it is this fear that will continue to motivate us to figure out more regarding
autism; its causes and cures. As of right now, autism is an incurable condition. Those who are
diagnosed with it must live with the condition throughout their entire lives. Despite the fact that
we may never figure out the causes behind autism, it is clear that while genetic variation,
prenatal care and air pollution do have a direct effect on a child's likelihood of developing the
condition, they are not leading factors behind the bulk of America’s newly diagnosed autistic
population. Instead, it is the extensive diagnostic changes implemented within the past decade, as
well as an overall increased national awareness surrounding the condition which have caused the
amount of autism diagnoses to skyrocket in recent years. Regardless, it is exceedingly clear that
as time progresses more and more people are going to be diagnosed with autism. Americans will
have no choice but to adapt their society to its ever changing population. Fortunately, with time
comes growth. It is certain that our knowledge surrounding autism will widen, bringing us one
step closer to providing autistic children and adults with the proper care they so rightfully
deserve.
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