Behavioral Banter

A Behaviorist’s Blog
Richard Couch, PhD, BCBA-D
CLASS North Bay Regional Director

Welcome to the first posting of Behavioral Banter, a periodic blog written to educate, entertain, and encourage those who care about services for individuals with special needs and their families. In subsequent postings you will find a Behaviorist’s view of various topics ranging from the philosophical to the legislative, and from in-home programs to life after public education. This blog will address concerns affecting all of us who care about the application of behavioral principals (Applied Behavior Analysis) as we strive to improve the human condition for all.

Today’s topic: Is Autistic Spectrum Disorder an epidemic?

In the 1940’s Austrian pediatrician Hans Asperger published Autistic psychopaths in childhood. Soon after Leo Kanner published Autistic disturbances of affective contact, and his seminal work, Early infantile autism 1943–1955. During this time what we now know as Autistic Spectrum Disorder (ASD) was considered very rare and mysterious. In the 1970’s however, the estimated incidence was considered approximately one in 2,000, and more recently this figure is one in 68. The California Department of Education reports the number of students diagnosed with ASD in public schools has increased from about 14,00 in the year 2000, to nearly 100,00 last year – seven times greater! Ostensibly something is happening.

During this time the revisions of the DSM criteria for ASD has changed in conjunction with more public awareness and new regulations mandating third-party payment of ASD therapy. Might the spotlight on ASD in conjunction with insurance benefits result in an increase in diagnosis? An extremely large Swedish study in 2015 examined over one million children from 1993 to 2002. The incidence of ASD increased from one in 435 to one in 200. It should be noted however, that the incidence of people with autistic symptoms remained constant at a little less than one in a hundred. Lead researcher Christopher Gillberg states, “. . . our findings indicate the only thing that has increased is people’s views of autism . . .” “In many countries, autism is the most talked about and accepted of all developmental disorders, and getting the diagnosis means getting access to good services. . . “.

Let’s compare, for a moment, the incidence of ASD with another health concern of epidemic proportions – senile dementia. Each day in this country a little under 11,000 (10,829) children are born. If one in 66 children is diagnosed with ASD, then over 160 per day or nearly 7 per hour will be diagnosed with ASD in the United States. Now the “greying of America” phenomenon has 10,000 seniors turning 65 each day in America. The medical community estimates the rate of some form of senile dementia as about one in ten. Hence, 1,000 seniors per day — over 40 per hour – will develop some form of dementia– seven times greater than ASD!

So which is it? Is ASD really an increasing epidemic, or is this phenomenon the result of new criteria, social services, public acceptance, and regulation? Time will tell, but this we do know: epidemic or not, children diagnosed with ASD and their families do not have the luxury of hypothesizing on such matters – they are too busy trying to get from one day to the next.

Increasing prevalence or not, we need to maintain an optimistic perspective. Consider the following quote from no less than Winston Churchill: “Attitude is a little thing that makes a big difference.”

Let’s make a difference where we can — that’s one behaviorist’s opinion.