"Bear in mind that the wonderful things you learn in your schools are the work of many generations, produced by enthusiastic effort and infinite labor in every country of the world. All this is put into your hands as your inheritance in order that you may receive it, honor it, add to it, and one day faithfully hand it to your children. Thus do we mortals achieve immortality in the permanent things which we create in common." - Albert Einstein

Tuesday, July 28, 2015

Autism Rates on the Rise?

Both autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) rates in the United States are on the rise. For ADHD, the Centers for Disease Control and Prevention (CDC) reported that ADHD diagnosis by a health care provider increased by 42% between 2003 and 2011. For ASD, the CDC reported a prevalence of one in 150 in 2002, but in 2010, the prevalence had soared to one in 68, a 150 % increase (three times the rate of increase in ADHD diagnosis). 

With these increasing rates, it is easy to relate to a statement made by health economist Richard Scheffler in an interview posted on the American Psychological Association's website:
"That's when we knew we were onto something, because if you want to improve test scores, one way of doing that is to have children diagnosed so you can get extra money from the school district to help tutor them or put them in smaller classes. Basically, you diagnose these kids because improving their performance helps the school's performance. 
Some states even allowed you to take students diagnosed with ADHD out of the pool that was used to judge your school, with the understanding that these kids probably perform lower, and if you have more of them, that shouldn't be held against you."
Scheffler co-authored with psychologist Stephen Hinshaw the book, "The ADHD explosion: Myths, medications, money, and today's push for performance". The smoking gun behind the above statement is not just the correlation between the rate of ADHD diagnosis and introduction of standards-based education reforms, but also the observation that there is no similar rise in ADHD rates in private schools.

The rise in autism rates is even more remarkable. A press release from Penn State University provides an explanation.

This graph shows the number of students (per 10,000) diagnosed with autism (blue) and intellectual disability (red) in special-education programs in the United States from 2000 to 2010. The increase in autism diagnoses during this period was offset by decreases in the diagnosis of intellectual disability, suggesting that shifting patterns of diagnosis may be responsible for increases in autism diagnosis. Credit: Penn State University

The press release and the above figure are based on a research article published in the American Journal of Medical Genetics Part B: Neuropsychiatric Genetics.

Obviously, it is beneficial that a school is aware of the needs of every child. The benefit arises from the expectation that the school then adopts measures and interventions to help address a child's needs. The case of autism, however, raises serious concerns as this disorder obviously encompasses a wide range of challenges. The following quote from one of the authors of the Penn State study, Santhosh Girirajan, is illuminating:
"For quite some time, researchers have been struggling to sort disorders into categories based on observable clinical features, but it gets complicated with autism because every individual can show a different combination of features. The tricky part is how to deal with individuals who have multiple diagnoses because, the set of features that define autism is commonly found in individuals with other cognitive or neurological deficits."
Obviously, if the rise in autism is mostly due to categorization, this is not really useful in understanding autism. Equally disconcerting is the observation that autism is becoming a catchall for all problems. The categorization being too broad does not really help inform educators on what measures or interventions should be taken. Meetings on an individualized education program (IEP) sadly can degenerate into simply filling up paperwork to ensure that the school gets additional funding.

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