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Sunday, 6 April 2014

Autism: An apparent increasing incidence means it is time to focus attention as a public health issue.

CDC recently released updated estimates of the prevalence of autism spectrum disorder (ASD).  The project is a longer overview based on 11 sites and a series of reports.  The 2010 report being released in the past few weeks at ASD  March 2014, and previously for 2010 at ASD March 2012.  The reports are well worth reading as an initial attempt to begin treating autism as a public health problem.

Given the long standing misguided implications of those that chose to relate autism with vaccines, the main disservice has been the relative ignoring of autism as a public health issue. 

There are several theories why incidence is increasing, or at least diagnostic cases are increasing.  Better definitions, better and expanded diagnostic tools, greater public awareness, and more parental concern may be contributing.

There is some evidence of a genetic component.  Many theories suggest environmental factors without definitive conclusions or relationships.  If only a fraction of the dollars spent on disproving the vaccine-autism link had been better directed to treating autism as any other emerging illness.  In this respect, the relatively small investment in the Autism and Developmental Disabilities Monitoring Network is a pittance but a valuable investment.

The general incidence in 8 year olds in the collective study area was 1.5%.  Notable is that of the 11 sites reporting in 2010, there is a nearly 4 times difference in rates between the highest incidence site and lowest.  Males are 4.5 times more likely to be diagnosed than females.  In typical US fashion, significant variation exists between ethics groups.

Over time a higher proportion of those diagnosed with ASD area found in the normal or above normal intellectual ability with 31% below IQ range of 70 and an additional 23% in borderline intellectual range (76-85).

A nice summary also by the CDC looks at treatment and support options for children and those with autism CDC autism treatment options  Another autism controversy that has detracted from applying scientific rigour has been the debate between treatment types with widely touted highly intensive therapy costing tens of thousands per year advocated for by the autism community with minimal evidence of better outcomes than lower costing standard therapies.  The lack of rigourous trial methodology fuels the controversy. 

Public Health has been instrumental in reducing outcomes of disorders identifiable at birth, in mitigating the impacts on children with developmental and communications disorders, and placing emphasis on the needs of children in general.  Its time again to step to the plate, doubly so given this appears to be an emerging illness.  

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