AUTISM: Up, up and away?

Private Eye, May 2002

 LAST year the Medical Research Council review of autism concluded that autistic spectrum disorders (ASI)s) in the UK now affect 60 out of every 10,000 children or one in 166. With masterly understatement it said: "These estimates make autism spectrum disorders far more common than was previously generally recognised."

The Oxford Textbook of Psychiatry put the figure at 1 in 2,200 back In 1988, the year that MMR was introduced in Britain. That means there has been a more than tenfold leap in the last 14 years.

The MRC suggests that differences in diagnosis and study, along with greater public and professional awareness, are likely causes of some if not all of the increase. Certainly these will account for a significant number of the new cases, especially among those at the higher-achieving end of the disorder with Asperger’s Syndrome, which would not previously have been recorded.

Rett’s syndrome, associated with regression and developmental delay, typically affecting girls, also became diagnosable in 1984.

But talk to teachers, health workers, local education authorities and autism specialists, and they are convinced that they are encountering more damaged children than ever before. If the rise is simply clue to better diagnosis, though, where are the newly diagnosed autistic adults? Two studies, in the US and Sweden, were designed to find these missing cases but singularly failed to do so.

In North Dakota researchers found that among children born between 1967 and 1983 the rate of autism was 3.26 cases per 10,000 children. Looking at the same children 12 years later, they found the original study had identified 98 percent of the autistic children — only one child had been missed.

In Sweden, researchers screened adult psychiatric out-patients for undiagnosed ASDs and found 19. But that still only gave a rate of 2.7 per 10,000, again providing little support for the thesis that better diagnosis and awareness had been the main cause of the rise in autism rates.

Earlier diagnosis along with improved awareness of autism among clinicians have also been cited as possible factors. But a recent study of a database of GPs around the country gave no support to this notion.

Most people working in the field suggest there has been a real rise in autism rates.

Even two studies looking at autistic children in north London, cited by the government as proof that there is no link to MMR, concede that there has been an unexplained increase. Countries around the world are only just becoming aware that they might be sitting on time bomb for their educational, social and health services, and axe only just beginning to collate figures. A study for the Centre for the Economics of Mental Health suggests the Individual lifetime cost of an autistic child is more than 2.4m: a huge bill for the public purse every year.

Despite a recommendation from the Commons health committee in 1997 that Britain should start a register of autism, the government has refused to do so, Hence the lack of comprehensive figures in the UK. The studies that have been carried out, however, are alarming: they suggest autism is indeed escalating but only among young children.

A small East Surrey survey of three year olds found that one in every 69 boys was autistic. This was one in 139 children when combined with girls. Wakefield education authority found that between 1992 and 1999 the number of autistic children rocketed from five to 111. Telford had four new cases a year in 1990 but l7 a year by 1998. An unpublished study by the University of Sunderland found a ten fold increase in autism from 1989 to 1993.

In Shetland, every diagnosed autistic person is under 15. A similar and unprecedented autistic "cluster" has emerged on Jersey, which has recently opened a special school for sufferers. The Autism Research Centre at Cambridge University, looking at children aged between five and l1, foundarate of one in 175.

Previous work suggested the rate was one in 2,000.

In Scotland the school census has included autism as a category since 1998, since when it has shown a year-on-year increase. The census in 2000 showed a 31 percent increase over 1999. Meanwhile, an independent researcher, Dr Stephanie Pywell, has found that the number of children in England with special needs has shown a marked year on year increase since 1991. Coincidentally this is the year the first children to receive MMR would have entered full-time education.

The increase offers no proof of any link, but is another time connection that needs investigation. The education department assured her it had used the same criteria for assessing special needs since the beginning of the 90s.

Autism is rising outside the UK too. Finland and Sweden have both recorded substantial increases in recent years. New Zealand has seen a seven-fold rise. But it is in the US, which records figures state by state, where there is mounting evidence of an autism "epidemic".

The US department of education monitors all children who are registered with an autistic disability. Its latest figures show that some states have shown huge increases between 1992/93 and 2000/1. Alaska has risen from eight to 195; Arkansas from 30 to 671; Montana from 20 to 163; Delaware from 15 to 263. Even if one allows for migration, earlier and better diagnosis and diagnosis of those at the higher end of the spectrum, a steep rise is still suggested.

In some cases individual towns have been concerned that they have "autism clusters" with 60 out of New Jersey’s Brick Township’s 8,896 children now registered as autistic; and Round Rock, Texas, recording 115 children as against only six, nine years ago. In fact for every two registered school age children with autism in the US in 1993, there were 11 by 2001.

California shows an almost five-fold increase registered with the department of education, from 1,605 in 1992/3 to 10,857 in 2000/1. But the most detailed information comes from the Autism Research Institute of California which has been collating data —including information on the age symptoms appeared - since the mid-60s.

What is interesting about this data is that up until the early 80s, children who were autistic from birth — classically autistic —outnumbered those who regressed at about 18 months by two to one. But in the early 80s, when MMR was introduced to the US, the pattern started to change and more parents reported their children’s decline into autism.

Today the picture has been completely reversed and cases of "regressive" autism are outnumbering birth autism by two to one. Dr Bernard Rimland, director of the institute, said: "Some experts will tell you that the increase reflects only greater awareness. That is nonsense. Any paediatrician, teacher or school official with 20 years’ experience will confirm there is a real increase, and the numbers are huge and growing."