If autism is on the rise, then there are far more children than adults with the disorder. If it isn't on the rise, then the numbers should be more or less consistent over the years.
Certainly there are far more children than adults with the diagnosis. But since the diagnostic criteria have changed radically since I, at least, was a child, that information doesn't help us much. And large studies, so far, seem to suggest that there both ARE and ARE NOT as many adults as kids with the symptoms of autism spectrum disorders.
If there ARE as many adults as kids on the spectrum, as some studies suggest, why didn't we notice them?
Actually, there are quite a few reasons why this might be the case - though there's no way to know whether these reasons, combined, actually provide a solid case for the "no rise in actual cases" argument. A few possible reasons:
- We didn't ignore them. We just called them by different names (obsessive compulsive disorder, mental retardation, etc.) or described them in terms of personality traits (shy, standoffish, nerdy, etc.).
- We pushed people with significant differences into the background or beyond. Certainly, when I was a kid, it was extremely rare to bring a person with an obvious mental or developmental disability into a public place, let alone a general education classroom. As a result, I very rarely saw such people - period.
- We were far, far quieter about disabilities and disorders than we are today. In fact, it wasn't all that long ago that we called cancer "the big C," and hid it even from those who were dying from it. Today, we march in the thousands wearing "awareness" shirts, hats and bracelets to proclaim our connection to everything from breast cancer to cerebral palsy.
- Autism has become far less of a stigma today than are many other developmental or mental disorders. While it's still very tough to talk about mental illnesses such as schizophrenia or even bipolar disorder, autism is the subject of conversation on talk shows and even at many parent get-togethers - even when there's no special reason to bring the topic up.
What do all these reasons add up to?
Summed up together they add to the argument that the increase in autism spectrum diagnoses is not wholly reflective of a rise in actual cases of autism. And that's it. Not much help to those trying to come up with an absolute or final answer to the question posed in the headline above... but fascinating fodder for the ongoing debate.
You many not have seen anyone with a disability but did you hear about any families with a family member with a disability? I lived in a community where you knew everyone and pretty much knew their business too. If a family had a child placed in care/an institution or hidden at home, we would have heard about it. I am in my forties and I have to say the first time I saw an young adult flapping and stimming was at an autism meeting a few years back.
Lisa
Can you point to anyone who claims that the increases in autism diagnoses is entirely attributable to actual increases?
Everyone I have read on the subject acknowledges the obvious factors of diagnostic definition change and “ascertainment” as described by Dr. Insel of the IACC.
It is the 50% of the startling increases that ARE NOT explained by diagnostic change and social ascertainment factors that is at issue in assessing what is happening with the stunning increases in autism diagnoses.
These are such great points! I remember those kids who were considered the shy and often “weird”. As a grandmother of a child with Autism, I am grateful that things are much more understood and that she won’t have to suffer not being understood.
Thanks for your post!
Leigha
Harold – no, you’re right, and you’ve absolutely acknowledged that the changes in criteria and other issues has been a big factor in the increase.
But it seems to me that the 50% number you cite is very much open to debate. With studies pointing in every direction, and record keeping so spotty and confusing, how could we possibly know that “50% of new autism diagnoses can’t be explained by anything other than an absolute increase in the disorder?”
As I’ve said, I’m guessing there is an increase. But IMO, the size of the “true” increase probably does not amount to anything like an epidemic.
Of course, that doesn’t mean it doesn’t matter!! Nor does it mean that studies are pointless.
In fact, if we really believe that the CDC is correct, and that autism is at about 1:110 with relatively little increase over time, it may be that our standards for social communication, our educational techniques, our expectations for independence, etc., may all be too high for a significant proportion of the population overall!
To me, that speaks for a huge overhaul of networks of support for adults at all levels of autism.
Lisa
Lisa
I agree that everything is open to debate on autism issues. But consider the source of my 50% figure. Dr. Tom Insel, Director of the IAC, is not exactly a flaming radical autism environmentalist and he has access to all the studies and data.
Consider also the acknowledgment by Dr. Insel of the likely role of environmental factors (pointed out several times in the past by Dr. Simon Baron-Cohen) in causing autism and the almost exclusive focus on purely genetic based research over the past decade.
It is time to take the autism increases seriously, have the environmental research done (without ignoring or forsaking the genetic component) and finding out what factors are causing the increases in autism disorder diagnoses.
I am endowed with Asperger’s Syndrome.
It’s been ten years since my brother was diagnosed with Asperger’s, and I started learning everything I could about AS with scientific rigor (I have a “rocket scientist” education).
My observations after ten years of study:
Essential autism and AS almost certainly must be different degrees of the same genetic defects because of the commonality in relations.
Many children who would meet diagnostic criteria for autism end up being adults with AS.
People with AS get married less often; when they do marry, they marry later, and assortive mating often occurs.
The majority of adults with AS continue to go undiagnosed, and there is very little plus side from getting a professional diagnosis, for it establishes a pre-existing condition which may affect the ability to get insurance or employment.
The autism statistics and studies are a mess because too few researchers organize the studies by base cause, i.e. genetic versus fetal trauma. In my personal opinion this is incompetence, since the fetal trauma cases are often so easy to discern by facial and dental deformities, rotated ears, compromised vision and hearing, etc.
The failure to categorize autism by type results in ambiguous studies, misdirects precious resources, and results in misinterpretations of treatment efficacies and wasted or useless treatments.
Fact: A rigorous and well designed British study released last September found the number of adults with autism spectrum disorders similar to published numbers on children.
Certainly autism was ignored in the past; especially Asperger’s Syndrome. Sometimes I wonder what my life would have been like if I had gotten a diagnosis of AS at a young age; I probably would have been set aside, and my spectacularly successful career would never have happened. My oldest son obviously has AS, and when he had trouble in school (pre 1994 DSM IV) he was diagnosed by one shrink as having some sort of schizophrenia and the shrink recommended he be institutionalized. (I rejected that recommendation because I recognized my son was no different than myself and most of my brothers and male cousins.)
Another perspective on Asperger’s syndrome having been around a long time is the number of posthumous diagnoses: Einstein, Dirac, Newton, Tesla, Orwell,
Da Vinci, Van Gogh, Ben Franklin, Jefferson, and the list goes on….
Hi Lisa,
While I agree that some increase may well be due to the factors you mention, it does not seem plausable to me tha such a huge increase in diagnoses does not also represent a real increase. Particularly when figures seem to show increase in recent years when less of those issues would seem to apply.
If as you suggest, there has been no increase though, then the much discussed need for adult services would also not be real; if we have always easily found places for non independent adults with autism, then whether they had an actual “autism” diagnosis or not,they were taken care of, and provided with support and places to live.
Social security should easily continue to support these new numbers of adults with autism, as in that case it has always done so, if perhaps under a different diagnosis.
Hera – actually, I didn’t suggest that there’s been NO increase, just that the increase is not necessarily representative of an “epidemic.”
Re adult services, I’d suggest that we are learning that adults who would, today, be diagnosable with an autism spectrum disordered have NOT all done just fine. In fact, many have fallen through the cracks, both as kids and as adults. Quite a few have a very tough time indeed.
Lisa
I, like Harold, am much more inclined to defer to Dr. Insel on this issue (as well as the special ed and adult services policy folks) than the growing number of “self-diagnosed” adults and other naysayers. In my view, of particular concern and focus in terms of rapid growth rate should be the “regressive” autism subtype. While some of the “self-diagnosers” may indeed qualify for a diagnosis of autism, any diagnosis should be done by professionals who specialize in the field.
Anecdotally, I’m told many pediatric neurologists are experiencing explosive growth in their autism patient loads, and that includes my teen’s specialist, who has provided his care for over a decade. This particular neuro’s next opening for an “existing patient” appointment (as of last week) is mid-summer! I’m also told that Dr. Buie and other GI specialists like him have even longer waiting times!
Sorry Lisa for incorrectly stating your viewpoint, I only just read your previous article and comments, and missed that you had pointed out the current rate is likely to be a mixture of real increase and artifacts.
Suspect that in this current generation, the frequency of severe autism has increased, and that whereas people with mild aspergers from previous generations could find ways to integrate into our society( maybe with difficulty), I suspect that many of todays children and young adults do not have just mild aspergers .
Certainly there were in the past some people with severe autism who required life long care; my suspicion is that we will find, as the 80’s generation and beyond grow up, many more of these cases than previous generations have ever had to care for, under any diagnosis.
Hera – whether the “reality” is what you describe or not, the perception surely will be.
In the past when people moved back into their parents’ basements or dropped out of school or went from job to job because of social/communications issues, they were simply thought of as losers. Unless they demonstrated obvious mental illness or cognitive deficits, they didn’t get treatment or therapy: they got pep talks or dressings down.
These days, people with difficulties managing “real world” social communications demands are far more likely to receive a diagnosis of one sort or another – and therapies and/or supports.
IMO, it’s a change in culture as much as it’s a change in some absolute set of realities.
Lisa
It is absolutely preposterous to argue that there has always been anywhere near the rate of autism that we have today. This flies in the face of studies and experiences and the memories of countless middle aged professionals (teachers, psychologists, etc.) and our history books and fables and pre-21st century literature where you don’t see stories of any typically developing toddlers who suddenly forget how to talk and developed seizures and chronic diarrhea.
Yes, there were always nerds and geeks and loners, but full blown autism was extremely rare.
The reluctance to accept that there is a very significant increase in autism is so nonsensical that the only plausible explanation is that many people in our health agencies and organizations and corporations are purposely denying the increase because they are afraid to admit to the causes.
Twyla – you say “our history books and fables and pre-21st century literature where you don’t see stories of any typically developing toddlers who suddenly forget how to talk and developed seizures and chronic diarrhea.”
If that’s the criteria you use to determine if someone is autistic, it (a) doesn’t fit the existing diagnostic criteria and (b) isn’t likely to appear in any book or fable unless it’s specifically a book or fable about a child with a disease, written to enlighten adults about the symptoms of a disease. If we’re really discussing kids with those specific symptoms, I can’t say how many did or do exist — but would assume that anything written about them is in the medical literature, and not in novels or fables.
I’ve most certainly read older novels in which characters DO fit a general description of autism. Children who don’t speak, or who interact oddly, or who don’t fully grasp social interaction. In fact, I’m presently reading the book Heidi with my daughter, and recognizing some of those symptoms in the character of the goatherd Peter! How common does that make autism in the past? I have no idea — I can only say that many of the symptoms we presently associate with autism can be found in many of the novels I’ve read going back as far as the 1700’s.
By recognizing more than one side to a controversy, I am hoping to explore the reality behind the rhetoric. IMO, both sides are building on FUD (fear, uncertainty and doubt) to make their cases.
You mention, for example “countless” middle aged teachers and professionals – but I have no way to know the specifics of how many people we’re really talking about, who those people are, how or why they might have been exposed to today’s autism spectrum in the past, etc.
I’ve found that a few people can make an awful lot of noise, making a small minority sound like a vast crowd. Before assuming I’m hearing from a crowd, I’d want to actually count noses.
Lisa
I get really tired of the hair splitting regarding statitics and definitions in relation to the topic of autism increasing. Yes, we don’t know exactly how much of the increase in diagnosis is a result of better diagnosis or expanded definitions, but I think that the combination of various studies (including those from the CDC and UC Davis) and school statitics, and data from agencies such as the California regional centers, are clearly showing a dramatic and real increase. You can look at Heidi’s grandfather and see signs of autism, yet unlike so many of today’s children with autism, he could speak in complete sentences and live independently, herding goats for a living and taking care of his basic survival needs on his own.
I don’t think it is necessary to quantify the number of professionals who remember there being much less autism a few decades ago. And, like many middle aged adults, I grew up in a small town where we knew other families very well. If my schoolmate’s baby sibling had not learned to talk and had either grown up at home or disappeared into an institution, we would have known.
Dr. Thomas Insel, Director of the National Institute of Mental Health, said recently:
“My personal sense, just from my clinical experience… when I was in training, I never saw a child with autism. So I went through four years of training as a psychiatrist, including a rotation – a long one – through a year of child psychiatry, and never saw a case. I got interested in autism through work I was doing in basic science research, and I wanted to see children with autism. I couldn’t find them. This was in the mid-1980s, and I had to find a specialty clinic at Children’s Hospital in Washington, and I got to see my first case there. And now I wouldn’t have to go any further than the block where I live to see kids with autism today. So if that’s not a change, I don’t know what is. On a personal experience basis, I don’t think that’s unusual. Most people who I’ve trained with would say much the same thing. So, of course, I think all of us are much more aware of autism than we would have been 20 years ago. And again, I want to stress, I don’t think it’s just a difference in awareness, I think that there is something that we need to get our hands around here.”
http://www.ageofautism.com/2009/12/david-kirby-dr-insel-on-rising-asd-numbers-no-question-about-environmental-factors-.html
I think these kinds of statements are significant, especially in tandem with the various statitistical studies.
Bottom line — Sure, we could have ignored mild high functioning cases of autism. But many kids these days have severe deficits in communication and other issues impacting basic life skills, behavior, and the ability to live independently upon reaching adulthood. All that would be pretty hard to miss.
And although I don’t have hard data at my fingertips, I have the impression that milder conditions are more common as well, such as ADHD, and various other learning and behavioral issues.
Twyla, I really don’t know how to get my brain around Insel’s comments, especially since he refers to “autism,” which makes me itch. What does he MEAN by autism? Classic profound autism? Autism spectrum disorders? Autistic disorder?
Heidi’s grandfather (along with other characters in that and many other books) are pretty darned similar to adults with HFA/AS that I’ve met. And of course novels in the past didn’t deal with lots of topics — you’d think there was no sex prior to the 1970’s if you went by how many sex scenes were actually written into novels!
There are certainly plenty of studies and statements that suggest dramatic growth. Ditto moderate growth. Ditto relatively small growth.
IMO, it matters because the way we think about autism spectrum disorders will vary dramatically depending upon whether we’re seeing a medical disaster or a small/moderate change.
Lisa
Well, I guess it could be argued that the only thing we know for sure is “Cogito ergo sum”.
We’ll see ten years from now what kind of impact today’s generation of kids has had on adult services and social security disability claims.
Lisa – Your personal experience, while important, seems to overly inform you about the total population of those affected by autism. It is crystal clear to mainstream medical specialists that there is “more” autism. The question is what subtype (and there are at least four but probably more) has experienced stability or explosive growth. I’d encourage you to as a journalist to attend the next IMFAR and interact with the clinicians and researchers focused on this population before you and the NY Times buy in to Fombonne, et. al.
Dadvocate – sadly (for me) the New York Times pays no attention whatever to what I say or think, even though About.com is part of the corporation… sigh. You’d think there’d be some synergy, but not so.
On an unrelated point, I’m not sure what you mean by “It is crystal clear to mainstream medical specialists that there is “more” autism.” Fonbonne et al ARE among the mainstream medical specialists, and IMO their research is as worthy of review and reporting as anyone else’s. In fact, I believe he actually presented at last year’s IMFAR conference?!
Twyla, I guess in certain areas I’d agree: cogito ergo sum pretty much covers it.
When I see legitimate studies that are in direct contradiction to one another, I personally don’t know how to respond.
For example…
Is the UK study that shows no growth a meaningful or pointless study? How about the CA study that shows vast growth?
Both have their strong and weak points. Both were conducted by legit researchers. Either can be torn apart legitimately by those who believe that they are poorly constructed – and both can be supported, with justification, by those who agree with their findings.
“Could We Have Ignored Autism in the Past?”
The answer is; Yes and No.
Mild form of autism was common in the past. In the end, every person on the Earth has a few mild traits of autism.
The answer is: we have ignored autism in the past because it wasn’t significant differences between people/children affected with autism and typical children/people.
There is no way that the moderate and severe form of autism where ignored in the past.
The all research studies about prevalence and trend of autism showing only one result and that is: the classic autism is on the rise by each passing years.
The rising trend of incidence and prevalence of classic autism is denied only by the people who never done any research/study about prevalence and trend
Not only the developmental disorder and mental disorder conditions are on the rise but as well as developmental disability and mental disability are on the rise. This fact pointing out that there is no place to conclusion that the classic autism in the past is diagnosed as developmental disability or mental disability.
I have yet to see a logical defense of Fombonne’s use of one Quebec city for MMR uptake rates and a completely different city for the rates of autism to show that there is no link between autism and the MMR. I don’t see how anyone would think he has any credibility after that especially when one throws in the fact that he has testified for vaccine manufacturers.
I spoke with a speech pathologist today and since she started in 1993 she says she has seen a huge increase in autism. She said that whilst the increase in children with Asperger’s may be due to better diagnosing that wasn’t the case for those with more severe autism. That, according to her, is a real increase.
How many of you have one unvaccinated baby? I have one, and do not believe it’s a coincidence that he can hold a conversation at “just two”, is happy, calm and well adjusted. He asks his brother who outweighs him by 100 lbs, and is seven years older than him, if he’s okay, does he want something, and pats him gently. He sings little songs, plays pretend with his toys and when an “elderly” person sees him in action, they always, always say, he reminds them of children of a long ago era. Of course I want a safe shot for him, I fear disease just as everyone does, but the garbage they offer us now is just too contaminated for me to accept , it would be similar to me accepting food out of a restaurant dumpster, all of the nutrition yet a risk of “god knows what”. These elderly people don’t understand, they think we’ve become lax in discipline, overused television, in general have been bad parents, they see more than autism, they see a generation of behaviorally , socially, strange kids. This is new, don’t be fooled into thinking those NT children we refer to so often are normal, they aren’t, most kids seem somewhat affected. After the autism count, start counting those that are on various “mind altering drugs” for their ocd, depression, add, adhd..there are so many damaged that we should be screaming for answers not infighting over whether this is a “new” problem. My friends baby, age 14 months started with a few screaming episodes last week, this week three seizures, today more screaming, is that normal? Today we say, oh maybe it’s nothing, well fifty years ago it didn’t happen, find great grandma and ask if this now common occurance ever happened to any child. Eight weeks post mmr, seven weeks post h1n1… vaers..too much time elapsed to consider it??? Yet this child has been sick since that shot. I ask what immune system malfunction must occur after that shot to send so many back to their docs week after week with infection after infection for quite some time after receiving it. When does the brain damage start..hours..days..weeks..after these vaccines.. This child has it all, exzema, tantrums, seizures, bowel disturbance, and the doc said, he’s fine, probably nothing, we will watch him, he’s probably screaming because his stomach hurts. Next week he’s going to the allergist, sure they will get to the bottom of this. I’m sad tonight, I see another little boy stepping down from his position as perfect.
That stupid English phone survey finding that 1% of adults have autism was riduculous.
Lisa, if you agree with my “cogito ergo sum” comment it may not have been clear that I was being sardonic. My point is, we can question any and all knowledge as not being totally absolute, yet every day we take actions based on what we “know”. And I do think that many forms of evidence prove that autism has increased tremendously during the past 25 years.
Twyla – I got it, I really did. I understand that you’re frustrated with me, and that you’d rather I picked a set of research studies and stood by it.
I understand you feel that the English study was nonsense, and I tend to think it’s pretty flawed – but I’ve also learned that the California study has its own flaws.
I can go with my “gut” when it comes to decisions for my own child. I can tell you that one therapy just “feels” right for us while another doesn’t – or that I have seen “enough” studies to tell me what I want to do for Tom.
But I just can’t go with my gut on the issue of statistics.
Barbaraj just wrote:
“don’t be fooled into thinking those NT children we refer to so often are normal, they aren’t, most kids seem somewhat affected. After the autism count, start counting those that are on various “mind altering drugs” for their ocd, depression, add, adhd..there are so many damaged that we should be screaming for answers not infighting over whether this is a “new” problem.”
If I understand correctly, she’s saying virtually all kids today are damaged by something, and she knows this to be absolutely certain and true because of her own experience in the world.
She may be completely right. She may be absolutely wrong. Frankly, I DON’T KNOW, and to claim I do would suggest that I have information or understanding that I don’t.
I can tell you this much: I don’t believe that the fact that we’ve created categories to describe behaviors and medicines to change behaviors is proof that the behaviors or ways of thinking are new or more prevalent.
As I’ve said, I DO think the numbers of kids with autism have increased. I just don’t believe they’ve increased in epidemic proportions.
Lisa
Regarding my comment #24 my point was not that I am frustrated with you, Lisa, but that I wanted to be sure my comment was clear, because in your comment #19 you seemed to be saying that you agree we don’t know for sure. What I’m saying is that we never know anything at all in an absolutely absolute sense, but as much as we can know anything, I do believe there is solid evidence of various kinds proving that the rate of autism has increased substantially. It seems that this evidence is often held to a higher standard, as if it can be ignored until we have some kind of ultimate proof beyond anything that science or human perception are capable of.
And I would call 1% an epidemic. Webster’s dictionary defines the adjective form of the word “epidemic” as:
“affecting many persons at once” and “excessively prevalent”.
The noun “epidemic” is defined as:
“an outbreak of epidemic disease” or “an outbreak or product of sudden rapid spread, growth, or development, specif. a natural population suddenly and greatly enlarged.”
The word can have connotations of a communicable disease, but also encompasses other conditions.
Based on California state agency, school, and CDC statistics I would say that we have an epidemic. The prevalence is certainly excessive, affecting many families and school budgets, etc.
One of the more ridiculous arguements IMO is the arguement that parents of children without disabilities want their kids to get autism diagnoses to get special ed services. That is certainly not consistent with my knowledge/experience of parents.
I think you are exagerating Barbaraj’s comment a bit. She said that “most kids seem somewhat affected” and you ratcheted that up a notch when you say that “she’s saying virtually all kids today are damaged”.
I have no problem with you throwing out various sides of these issues for debate. I’m just disagreeing with some of what you have said.
Hey, Twyla. Thanks for the conversation, which is really making me reflect more deeply than I sometimes do on Sunday afternoons!
I guess if we’re going by the adjective form (“affecting many persons at once” and “excessively prevalent”) then I’d agree: we have a lot of people with autism spectrum diagnoses, so you could call it “epidemic.”
BUT.
Typically what people mean by the term “epidemic” is something closer to “an outbreak or product of sudden rapid spread, growth, or development, specif. a natural population suddenly and greatly enlarged.”
I think that’s the question: NOT “do a large number of people fit the parameters we’ve now established to describe autism spectrum disorders,” but RATHER “have the number of people who fit those parameters suddenly and greatly expanded?”
Again, I personally believe that the number has expanded, but not all that suddenly or greatly. But that, as I say, is matter of belief, not proof.
The reason I’m harping on this question is that I do think our response will differ depending on what we think we see.
A sudden, great expansion of any disorder calls for large scale, quick, focused action (a la the H1N1 vaccine). It also brings to the forefront the gigantic question of “what is causing this and whose fault is it?”
If you look, though, at the stats relative to allergies and asthma, you can see that there IS an increase, and that the increase has occurred over time. And there has been attention paid and research done. But people aren’t marching in the streets or ripping each other apart over a question of fault and blame.
Big difference in response. And personally I’m not convinced that the blame game is helpful when it comes to autism.
Lisa
I don’t know why a search for causation is called a “blame game”. If there were honest research on whether vaccines cause autism, and into biomedical treatments for autism, and treatment/study of vaccine injuries, there would not be people marching in the streets. What makes a lot of people (especially many parents) angry is that the autism-vaccine connection is treated like a taboo hot potato (to mix metaphores) instead of a subject to be fully investigated.
I don’t think the statistics on the increase in autism are any less convincing than the statistics on the increase in asthma and allergies, but there is not such a concerted effort to suppress the fact that asthma and allergies have increased.
Certainly vaccines could be contributing to the increase in allergies and asthma. There have been some studies on this, but I don’t think this possible link is receiving enough attention either. It only makes sense that if we give dozens of vaccines to infants this could affect developing immune systems in unanticipated way, perhaps overstimulating some who are more susceptible.
And now I’m off to the grocery store…
Just today there’s an interesting story that touches on this. The story asks if we have severly undercounted girls when diagnosingg autism. Its a real possibility.
Bottom line: anyone who thinks they know for sure that theres been an autism ‘epidemic’ or not is deluding themselves. We don’t have enough data to say one way or the other. Do the science and then we can say for sure.
One other thing to note – Dr Insel is not an epidemiologist.
When I see legitimate studies that are in direct contradiction to one another, I personally don’t know how to respond.
Two things to keep in mind:
1. No single study is dispositive. Of course there will be studies that disagree – even the creationists have their own journals and scientists and conferences. When you’re evaluating two competing studies, ask how each fits into an existing body of knowledge, or if the study replicates or builds on the results of an earlier study.
2. What is the “impact rating” of the journal where the study is published? Examples of high impact journals are NEJM, Pediatrics, Lancet. Low impact include Medical Hypothesis and JAPANDS.
There’s more here:
http://photoninthedarkness.com/?p=146
Hi Lisa,
I think you are on the right track here.
I believe there are two steps to investigating the issue.
First, one needs to verify that there are significant numbers of cases of ASD where the diagnosis was missed.
When one looks (e.g. at adults in institutions or by reviewing historic pediatric files) one finds many individuals that were never diagnosed with an ASD–but who should have been.
There is no way around this; a lot of cases have historically been missed.
Secondly, one then needs to do active surveillance for cases. Historic reported ASD prevalence numbers will be wrong.
There have been a number of attempts to address this issue using different methodologies and they all end up at the same place: about 1% of people have an ASD.
All we are left with is to argue over the precision and accuracy of these calculations.
Has ASD rates gone from say 1% to 1.1%?
Maybe, but the idea that there has been a massive increase in the rate is totally bogus.
W&N
Samaxtic,
You may have recently seen a couple posts about people being “anti-vaccine”.
I think your comments about Fombonne’s study are a good example as to why some sites/authors etc have been characterized as anti-vaccine.
Fombonne’s methodology is just fine–a common ecological study design.
There is a high level discuss of this in the Cedillo case (I think it is the day 11 testimony).
And there is some huge number of qualified
statisticians out there that can verify in painful details that his method is appropriate.
But I can’t find any of the vaccines cause autism sites/authors that get this topic correct–even after years of correcting their errors.
They don’t even have epidemiologists comment on the epidemiology studies. I believe that this is why
they are sometimes called anti-vaccine.
Anyway, you can look it up for yourself–just make sure you go to a reliable, qualified source for doing epidemiological research.
W&N
Hi Twyla,
Isn’t it interesting how different people can have such very different perspectives on an issue?
The only preposterous thing I see is a bunch of people that don’t understand epidemiology criticizing people that do understand the subject.
I will put my money on the side with knowledge and competency–people using valid methods to address the question.
You know stupid is a very strong word–one I prefer to avoid using. However, if it is your wish to do so…these sort of criticisms leveled against the UK study are remarkable stupid:
http://www.ageofautism.com/2009/10/1-in-100-how-the-uk-government-arrived-at-the-adult-autism-figures.html
http://www.ageofautism.com/2009/09/uk-government-farce-over-new-adult-autism-study-.html
Fortunately anyone that makes a good-faith effort can not possibly belief this nonsense.
All you have to do is to fact check the first paragraph of each blog entry–compare the entry with the words in the study. Basic literacy skills are all that are required to see that the blogs simply don’t tell the truth.
Fortunately this nonsense is mostly harmless.
W&N
W&N,
Please explain how what Fombonne did was “fine”; that is, using one city for uptake rates and then using another city for autism rates. Why would he not use the same population to show the no link he claims? My perception is that Fombonne was banking on the ignorance/indifference of people outside the border. Why are the majority of epidemiological studies that Americans use to “show” vaccine safety done outside the USA?
re: “Dr Insel is not an epidemiologist.”
True, but epidemiologists don’t have a monopoly on knowledge.
But, Dr. Irva Hertz-Picciotto is an example of an epidemiologist who says that autism has clearly increased, based on a recent study which evaluated many factors such as migration and better diagnosis, and found that those factors could only account for a small part of the seven- to eight-fold increase in the number children born in California with autism since 1990. This paper was published in the respected professional journal Epidemiology.
see h t t p : / / w w w . ucdmc.ucdavis.edu/welcome/features/20090218_autism_environment/index.html
According to Dr. Hertz-Picciotto’s bio at
h t t p : / / w w w . ucdmc.ucdavis.edu/mindinstitute/ourteam/faculty_staff/hertz_picciotto.html
“Irva Hertz-Picciotto, Ph.D., Professor, is an internationally renowned environmental epidemiologist who received her BA in mathematics, MA in biostatistics, and PhD/MPH in epidemiology from the University of California, Berkeley. During 12 years on the faculty at the University of North Carolina, Chapel Hill, and since her arrival at the University of California, Davis in 2002, she has published widely on environmental exposures, including metals, pesticides, PCBs, and air pollution, and their effects on pregnancy and early child development. She is also a foremost expert in epidemiologic methods.”
Here’s a comment from Autism Speaks Chief Science Officer, Dr. Geraldine Dawson:
“In the past several years, the prevalence of ASD has increased dramatically, underscoring the potential role of environmental factors in its etiology.”
Read her entire letter to the National Vaccine Advisory Committee, starting on page 13 at:
h t t p : / / w w w . hhs.gov/nvpo/nvac/documents/ASPAPublicCommentsFeb2.pdf
Dr. Dawson is not an epidemiologist, but she has a PhD in Developmental Psychology, a field in which the study of statistics is required — certainly enough to give her a grasp of how to read and understand research on prevalence. She was also a Postdoctoral Fellow at the Neuropsychiatric Institute, University of California, Los Angeles.
I don’t know how Kev can say there has not been any study of prevalence. There has.
For example, see h t t p : / / w w w .ageofautism.com/2009/09/autism-not-really-on-the-rise-967-impossible.html
The Maternal & Child Health Bureau of Health Resources and Services Administration (HRSA), US Department of Health and Human Services released a study finding that 1 in 91 children between the ages of 3 and 17 currently carry an ASD diagnosis -1 in 58 boys.
The CDC’s studies show an increase from 1 in 150 for 8-year-old children in 2002 to 1 in 110 for 8-year-old children in 2006.
School statistics from around the country show huge increases. See h t t p : / / w w w . fightingautism.org/idea/autism-prevalence-report.php
And there’s more… But I gotta go.
Hi Samaxtics,
Sure I can explain.
Many of these sorts of studies are done in countries with national health care systems because you can get better data–cheaper and faster. I hope this obvious to you now.
He couldn’t use the data for Montreal vaccine utilization because it doesn’t exist.
It is fine to use the vaccine utilization data from Quebec City because (1) ecological studies (by definition) look at the population level; (2) they validated the Quebec City data as being representative of the Montreal population studied.
More to the point, I already suggested how you can verify these points for yourself.
Either way we end up at the same end: despite years of correcting the errors, these false criticisms are still be promoted by people that claim vaccines cause autism.
W&N
W&N
If the uptake rates don’t exist for Montreal (and quite frankly that is not the case) then why didn’t he just use Quebec City for both uptake rates and rates of autism? You have done zip to correct any errors and the reason being is because you can’t. What Fombonne did remains indefensible. And that is why he chooses not to address it himself.
Twyla, I think I’ve given the wrong impression. I’m saying no science has been done that has adedquatley answered the question. It seems there has been a rise but whats important is what *sort* of rise – the type of rise we’d get if we suddenly found out that really girls were just as prevelant as boys, or the sort of rise that indicates a real genuine rise? Nobody knows.
I think Dr Insel has been very premature with his remarks and I don’t understand what *science*what *epidemiology* he is basing his remarks on.
“It is fine to use the vaccine utilization data from Quebec City because (1) ecological studies (by definition) look at the population level; (2) they validated the Quebec City data as being representative of the Montreal population studied.”
Indeed, and to make it worse for the people that criticise Fombonne for it, this was covered in the literature and policy review sections of the paper.
I would question whether anyone criticising him for using the Quebec figures has actually read and understood the paper. Sure, one can say it would have been ‘better’ to use local figures, but to call it an ‘error’ is to misunderstand – or simply not have read – the section of the paper that covers vaccination in the province.
As it’s not a small or easily missed section of the paper, his critics have got a lot of explaining to do.
The CDC’s studies show an increase from 1 in 150 for 8-year-old children in 2002 to 1 in 110 for 8-year-old children in 2006.
Nearly a quarter of the children identified as autistic in the 2006 study were undiagnosed until they were screened by the researchers.
I think perhaps those indicating that the Fombonne study is flawed because of the use of Montreal vaccination rates and Quebec City autism rates may have the stronger argument. The ethnic mix of Montreal is far more diverse than that of Quebec City since more recent immigrants to the country have been attracted towards settling in Montreal rather than Quebec City. Although both cities are under the same regulated health care system, it would not surprise me that the two cities may have very different vaccination patterns due to the differences in their municipal immigration patterns over the last 20 years.
My gut feeling is that there has been an increase in autism cases over the last 20 years that is not accounted for by the changes in the diagnostic criteria. My son was diagnosed first under the DSM-IIIR with PDD-NOS and I was told that the rate for all ASD’s at that time was 1:15,000 births. Several years later, his diagnosis was later reconfirmed under the DSM-IV (still PDD-NOS) and I was told the rate had risen to 1:500 births.
My point is that my son has always been on the milder end of the spectrum to the point that he now leads a fairly “normal’ life. Still, he was not able to just slip through the cracks. With the rates now in the order of 1:110 (or even higher) and so many parents expressing far more severe difficulties than I recall my son had with language and learning, I just find it impossible to believe that the entire increase could be solely due to missed diagnoses or even due to relaxation of some of the criteria for diagnosis.
Mary -
I don’t think the question is “has there been an increase,” because I think there clearly has.
The question, rather, is “how much of the apparent increase is an artifact of changes in diagnosis, etc., and how much is an actual increase in incidence?”
Much of the angst around autism today arises from the sense that we are in the midst of a huge, unexplained increase in actual incidence.
But what if only 10% of the increase in diagnoses were unexplained by changes in criteria and awareness? Of course, even 10% would be important and significant – but it would not be triggering the kind of overwhelming public reaction we’re seeing in the US and the UK.
I personally would like to take a measured, focused look at the group of children who are experiencing serious physical illness and regression, to better understand things like (1) are these illnesses and regressions really triggered by vaccines? (2) how many such children are there who have these specific symptoms? (3) did these kids have symptoms prior to vaccines? (4) what treatments are actually (and not anecdotally) helpful to these kids? (5) would it be possible to avoid autism in some children by avoiding certain environmental exposures, and are vaccines among the exposures to be avoided?
At this point, we don’t have solid, agreed-upon answers to ANY of these questions!
Lisa
Hi Lisa,
I think we are in complete agreement.
My point wasn’t just that there has been an increase, but that the increase has been too significant to be explained by changes in diagnostic criteria alone, particularly since milder cases (such as my son) were also being successfully diagnosed under the old criteria. I also think the percentage of milder cases as a part of the total number of cases being diagnosed must have been reasonably high, since I was given every hope that my son would “just outgrow” his diagnosis. As erroneous as this think was, it seems logical to me to assume that there must have been a relatively high percentage of fairly mild cases for there to have been this sort of “general impression” of how serious autism was. Similarly, the number of relatively serious cases (i.e. cases where the child could never be potty trained or speak or where there was serious self-injurous behavior) must have also been proportionately lower back then than they are today. A certain percentage of these serious cases may have indeed been given other diagnoses, but then I would think there would be at least some evidence of a corresponding decrease in the numbers of those “other diagnoses” to compensate for the increase in autism diagnoses. As far as I know, this does not seem to be the case. In fact, my impression is that diagnoses of many forms of mental disorders are also dramatically on the rise.
Of course, I’m not a scientist, so anecdotal evidence and a mother’s gut is all I have; but so far, the studies I have heard of have generally failed to convince me that there is no possible connection remaining between vaccines and my son’s autism or at least between environmental contaminants and his autism. Over his life, my son has had clinical reactions to more than one vaccine. From my point of view, I really don’t care whether the vaccine caused his autism, but I am concerned that he may be more vulnerable to experiencing ongoing vaccine reactions than people who do not have autism. I am not anti-vaccine. Despite my fears, he continues to receive vaccinations where we feel a significant risk of infection outweighs the potential risks to him (i.e. he did receive the h1n1 vaccine once the outbreak rate in our area began to increase significantly). However, I too would like to see some properly focused and significantly large studies investigating these areas (i.e ones that are so vulnerable to such criticisms) so that we could protect my son’s health on an ongoing basis from a better informed point of view.
As for the Fombonne study, I admit that I’ve not specifically read it and am basing my comment on the comments of the others before me. However, I do have a significant understanding of Canadian immigration patterns (since it has been one of the focal areas of study for me at university). Montreal and Quebec City are well known to have undergone two dramatically different patterns of immigration over the last 20-30 years and they are today two very different cities demographically. Further compounding the difficulties in coming to an analogous comparison between vaccination rates and autism rates of the two cities is the relative mobility of their populations. In Montreal this rate is much higher than Quebec City due to it’s popularity with young musicians and actors as a cultural experimentation center. It seems to me that when comparing infant vaccination rates and autism rates, it would be preferable to reduce the number of extraneous variables by focusing on cities where the overall population was less fluid and, of course, to use data for both rates from the same city. As representative cities of any size within any single province in Canada, the study could possibly not have chosen two that are more different demographically. Although various algorithms could be applied to negate some of these variables, IMHO, the overall results would likely still be vulnerable to such criticisms.
I also wanted to comment on the original premise stated in your post, that if autism was on the increase there would be far more children than adults with it and this doesn’t seem to be the case. However, the diagnoses of adults is generally based on current behaviors combined with mere rememberances of their behaviors as children. Unfortunately, one cannot go back and actually assess them as children, so there can be a wide margin for error in these assessments even though the criteria state that the behaviors must be present before age 3. It could be that the guilty environmental factors are gradually affecting all of us, causing an unknown percentage of the adults currently being diagnosed with autism to have developed those symptoms over time. We know they weren’t diagnosed using yesteryear’s standards and criteria, but we will probably never know how many may or may not have been diagnosed with autism as children if they could have been assessed back then using today’s standards and criteria.
“it would not surprise me that the two cities may have very different vaccination patterns due to the differences in their municipal immigration patterns over the last 20 years.”
I don’t think this is supported by the review in the Fombonne paper. In order for this to be a legitimate criticism of the Fombonne paper, a entire string of studies would have to be in error.
It appears to be a potential confounder Fombonne looked for and didn’t find.
Hi Dedj,
I understand how a non-scientist could be deceived by these false criticisms.
What I don’t understand is how a person can believe that they are working in their child’s best interest by refusing to learn or to even look at information.
Hi Samaxtics,
Instead of asserting that the uptake data exists for Montreal, why don’t you prove that this information exists?
The only thing that I see that is indefensible is personal attacks on Frombonne while simultaneously being unwilling to learn the facts.
You could read the actual paper–free full text is at Pediatrics site–it explains why they didn’t use Quebec for both autism and MMR data.
You could read the previously suggested court transcripts which would have answered more of your questions.
You could even follow my previous suggestion and Google ecological studies and learn a bit about how these studies work and verify my answers.
Or you can choose not to look.
W&N
Hi Mary,
The vaccine utilization could have been very different between the two populations–this is exactly why they validated the data–but as it turns out it wasn’t different.
Again I think this is explained in the day 11 testimony in the Cedillo case.
W&N
“I understand how a non-scientist could be deceived by these false criticisms.”
Indeed, I’m a non-scientist (although a health professions student) and when I originally heard of the ‘error’, my thoughts were that Fombonne should have been more careful.
Then I read the paper. Fombonne’s action would only constitute an error if it invalidated the purpose of the data. As the review section clearly covers, there is strong reason to believe provincial coverage is fairly homogenous.
When people call it an error, they’re either lying about reading the paper, or they haven’t understood the discussion. Not people I’d want a debate with either way, yet they insist in having their opinion held higher than a respected researcher.
Is this the Fombonne study being discussed:
http://pediatrics.aappublications.org/cgi/content/full/118/1/e139
If so, I believe the vaccination rates surveys mentioned may have been based on data for the entire province of Quebec (which would be inclusive of Montreal and not just for Quebec City). I have only done a quick scan of the PDF article from Pediatrics, but the study as described seems also to have relied on PDD diagnoses rates from within a single Anglophone school district. If I am correct and the references to Quebec immunization rates are provincial (rather than related only to Quebec City). It should be noted that the Anglophone population of the province of Quebec does tend to congregate specifically in Montreal and does comprise a generally different ethnic/genetic demographic than the Francophone population.
I’m not about to guess why the study I’m reading about chose to focus on an Anglophone school district in a predominantly Francophone province. I don’t profess to be qualified to even guess whether the results of the study are potentially invalid as a result. All I was trying to say before was: If population-based studies are to be accepted without criticism, then my uninformed gut tells me that it would make some sense to first choose cities where such complex demographic variables do not exist and to at least not mix half of the equation from one region with another that is significantly different from that demographic perspective. I agree with Lisa, I would like to see some vaccine studies focused in the areas where I have more specific questions that also need to be answered since the question of whether or not it is as safe to vaccinate my son against new outbreaks as the general population is an ongoing dilemma for me.
Accepting without criticism hasn’t been mentioned as far as I know, so I’m beginning to suspect you may be setting up a strawman.
What is at issue is the blanket simplistic criticism of the Fombonne study, without apparent knowledge of understanding of the actual content, especially the provincial vaccination review.
I would question whether many western cities do not have a complex ethnic mix. The proposed confounder you repeatedly refer to appears to have been covered in the review section.
Far from refraining from making a judgement on the paper, your choice of words indicates that you have decided that Fombonne used invalid data, and you appear to be implying that the confounder you mention is significant, even though the is no evidence for it in the review, and significant reason to consider it a minimal issue.
Nevermind though. At least you made an effortm which is vastly more than most Fombonne critics.
The article by Fombonne that I have been now reading in more depth (Pediatrics 2006; 118: e139-e150) acknowledges a limitation in the study as possibly being uneven migration of parents with children diagnosed with PDD’s into the specific school district because of that district’s reputation in dealing with developmental issues and it also indicates that data from other school districts were not available in order to test the hypothesis that the autism rates in this board may have been overstated as a result. Am I missing something and this issue subsequently cleared up?
The article I’ve been reading does not mention any possible skewing of the data due to uneven migration patterns of Anglophone immigrants to Montreal vs. Quebec (province as a whole, not city) and does not discuss how it isolated children who were in attendance in the school system under study but who may or may not have been immunized prior to their arrival in the province of Quebec. For the main part of the study, such immigrant children were almost certainly included since all the children in the school system were included. The article does state that a validation of the trend was done using only “a subsample of 158 Quebec-born children.” Presumably these 158 were all Anglophones, since the whole sample was limited to an Anglophone school district. It does appear, however, that validation still relied on the general cohort uptake of 93.2% (for the MMR), which was for the entire province.
To avoid skewing the results, therefore, it would require that the uptake of the MMR in the province of Quebec was roughly equal among the Anglophone and Francophone populations. This may certainly be a correct assumption (i.e. I can see no reason why Anglophones would be arbitrarily more or less compliant than Francophones regarding vaccination programs). However, I am curious as to how they went about validating that portion of the data since (as indicated in comments here) it seems that isolated Montreal-specific (or Anglophone-specific) uptake rates were not available.
Of course, as you point out Dedj, even if the uptake rates were skewed demographically, this may or may not have been significant to the conclusions derived by the study.
It does, however, leave an opening for further question that might have been avoided if a different city had been selected for the study.
Dedj,
You will notice that I have not made a reference to the “provincial review.” This is merely because I have not found a copy of it. So that I can at least read it in order to better understand the references you are making to it, would you please provide a link, if one is available.
Before accusing me of setting up strawmen, etc. please be advised that I was drawn into this thread by comments that indicated that the uptake data used by Fombonne were for Quebec City only (a region that would not included the study region within its boundaries (i.e. Montreal) and that has a a population breakdown dissimilar to that of Montreal. Upon reading the study for myself later, it appears to me that those comments making reference to Quebec City data (including those made by you) are based on a misunderstanding since the uptake data cited in the article refers to Quebec (the province) – a region that does at least include the study area of Montreal although the anglophone population of Montreal is not a parallel to the demographic breakdown of the province of Quebec as a whole. Forgive me for thinking that to have similar demographics on both the uptake and autism rate sides of the equation being studied MIGHT be of some significance to the overall quality of the study and how it MIGHT be accepted by the general public.
The accusations against Fombonne are that his use of data invalidates the study. We’re not discussing ‘mights’, especially not as these ‘mights’ are already discussed in the study, in the most obvious and relevant sections.
Where is the evidence that the use of the data was invalid? Please refrain from talking about ‘mights’, that is not the original discussion.
Dedj,
The original discussion IS flawed by the assumption that only Quebec City data and not Quebec (as a province) data were used. This does not accurately reflect the study parameters used by Fombonne and is, therefore, truly a strawman. One that was not introduced by me, but one that did suck me into this useless debate. END
Hi Mary,
Here is the link to the testimony:
ftp://autism.uscfc.uscourts.gov/autism/cedillo/transcripts/day11.pdf
The study is discussed several times at length. See e.g. page 178-179 of the PDF where they state that the data came from Quebec City and discuss issues like how far apart the two cities are. This seems extremely clear
to me.
But all of this is just a diversion from the real story here.
1–character assassination of the lead author is a poor substitute for understanding the subject.
2–fabricating problems with the study is just a way to avoid the data–which is pretty interesting data.
Did you notice that thimerosal exposure was reduced to zero and autism prevalence kept increasing? How could this be possible if thimerosal was causing the increase in autism numbers?
Similar results with MMR. MMR utilization went down and still autism cases increased. Again how could this happen if MMR was causing the increase in autism cases?
W&N
hi W and N,
Its strange how many things people have stated can influence rates of autism diagnosis. Some people in fact believe that “better awareness” is alone responsible for several 100 per cent ? increases.
We do know that there are likely multiple causes of autism. Fragile X syndrome, maternal intake of sodium valporate , maternal rubella infections, tuberic sclerosis, brain damage at birth, and per the Hannah Poling case, exposure to multiple vaccines other than the MMR, etc. Lots of compounding factors..
So ignoring other flaws in the study and collection of data for the moment, we have all been told again and again that rising diagnostic rates in no way reflect the “true ‘ rate of autism.
Do you believe that diagnostic rates do in fact reflect “true” increases in the rates of autism??
If you do believe that there are factors like better diagnosing that are effecting rates of autism, then a rise of diagnostic rates in this study means nothing, and cannot be used to extrapolate where “real” rates of autism have gone up or down..
Hi Mary,
You seem to have changed topic, OK….
I think I have already posted what I believe: that any real increase in the prevalence of ASDs is so small as to be undetectable with our current data/methods. That reported rates are different from true rates, but they are getting closer.
I can also tell what I know:
1–that determining the true prevalence of ASDs in a population is extremely complex and technically very challenging.
2–that the vaccines cause autism authors have done an extraordinarily poor job of communicating the basic facts and issues on the subject of ASD prevalence.
3–that by the late 1980’s researchers had good data the true prevalence of ASDs was at least 1% of all kids.
4–that the Poling case the concession was for encephalopathy and for seizure disorder–not for autism. And that HHS has written to David Kirby pointing this fact out and that they have never concluded in any case that autism was caused by vaccination. Mr. Kirby simple continues to write untrue statements about this and other cases.
5– that you have misstated the interpretation of the Frombone data. Thimerosal exposure was reduced to zero and ASD rate continued to increase unaffected. Conclusion: even if one can’t exactly define what factors were causing the increase in ASD diagnosis, thimerosal wasn’t one of them.
I choose to believe that when it comes to the health of our children most people would rather learn than resort to character attacks.
W&N
Hi W and N,
Actually I think perhaps you were responding to me ( Hera) and not Mary , who has not recently made a comment??
In the Forbonne study, my understanding is that the rate of autism and aspergers disorder combined that he found was 2.7 in 500.
This is a bit more than half the current rate; 5 in 500/1 in 100…So either he was missing a whole lot of autism cases ( almost half) or the rate has gone up recently ..a lot…
Many have wondered if the removal of one neurotoxin ( thimerosal) and the replacement of it with another ( aluminium) may have been a cofounder anyway in this study..It would have been interersting to note what other viral, vaccine and toxic metal exposures the children were receiving who were studied.
Also re the Hannah Poling case, encephalopathy, along with other causes of brain damage ( FAS, oxygen deprivation at birth) has had a known association with autism.In fact Maternal rubella infections can cause autism secondary to the encephalopathy the infection can produce.
( Also known as “a rose by any other name”….Since autism is purely diagnosed on symptoms, if encephalopathy produces autistic symptoms, the child in question has autism))
I don’t think there was anyone in the early 80’s doing research with a 1 in 100 autism figure ; but perhaps I’m wrong; could you point in out to me if so..
I agree with you that character assasinations are useless, poor science, and a waste of time. I am far more interested in good quality research designed to identify vulnerable sub populations.
Sorry looking at the 2006 study, it appears he had a rate then of 6.5 in 10000.
Interestingly he comments that the removal of thimerosal coincided with the addition of a second MMR shot in 1996. Prior to that apparently only one MMR shot was given.
All the best,
Hera
My apologies hera–I messed up.
About the 1% ASD figure, there are a couple of sources. I suggest starting with:
Kadesjö, B., Gillberg, C. and Hagberg, B. (1999) ‘Brief report: Autism and Asperger syndrome in seven-year-old children: a total population study.’
Journal of Autism and Developmental Disorders, 29 (4), pp. 327-331.
The key thing here is that they didn’t look at medical records and count number of cases.
Instead they took the entire population of kids born in 1985 (from one city) and actively screened the kids for ASDs. More than 1% of kids were found to have an ASD.
They also went back 4 years later and verified that
the diagnosis were correct.
In this population, 1% of kids born in 1985 had an ASD. This exemplifies the difference between reported and actual prevalence of ASD.
I can find some other work if you are interested.
About your comments on Frombonne.
Where was alu substituted for Thimerosal?
I can’t find any vaccines where the alu was increased.
Also, please be very clear that neither alu or thimerosal is a neurotoxin at the doses they are in vaccines.
Just like the mercury in the air you breath isn’t a neurotoxin.
Just like the alu and mercury in breast milk isn’t a neurotoxin.
And the autism numbers kept going up when, thimerosal exposure went to zero, MMR utilization decreased, second dose of MMR was added. These 3 changes did nothing. The conclusion is obvious.
Finally on Poling, a stem does not a rose make.
You have autism if enough symptoms are present. Lots of people have some of the symptoms, but they don’t have autism.
W&N
W&N,
I now agree that the uptake data was clearly from Quebec City, so my original concern with the disparity between the two populations of those specific cities still exists. Thank you for posting the appropriate link.
The population of Quebec City is more predominantly francophone, consisting of families descended from the earliest French immigrants in the 17th and 18th centuries; whereas, the Anglophone population of Montreal is not generally composed of this ehtnic group. Although the data in the study may or may not be affected by these factors, the selection of these two specific cities as opposed to two cities with more analogous populations does open a space for extraneous variables to affect the data. Asking questions about the design procedures of a scientific study does not arbitrarily constitute slandering the author of the study but perhaps will promote a similar study using populations that are more geneticly and culturally similar to be undertaken to verify the results of this one. Questioning science is one of the fundamental principles of advancing science. I frankly object to your implication that slandering the author was what I was doing in my earlier posts. As for the rest, I am simply refusing to get into this debate any further.
W&N,
I have also noted that there also appears to have been some confusion on your part between myself and hera making it difficult for me to truly ascertain which of your comments were actually intended to address my comments, etc. Your apology (made to hera) is also accepted by me.