It’s no secret that autism diagnosis rates have been on the rise in recent years. For the better part of the last decade, study after study has been conducted showing the rates of social-cognitive disabilities, especially spectrum disorders, have been steadily rising. As far back as 2005, psychiatrists and other experts have been looking into the diagnosis rates, as evidenced by such studies as Trends in Diagnosis Rates for Autism and ADHD at Hospital Discharge in the Context of Other Psychiatric Diagnoses (PDF link) by David S. Mandell, et. al. In that study, the authors find:
Substance-related disorders were the most common mental disorders recorded at hospital discharge and increased by 39 percent between 1989 and 2000. Affective disorder was the next most common diagnosis and increased by 138 percent. Although autism and ADHD were far less common, their diagnosis rates nearly quadrupled over the course of the study.
In the controlled setting of hospital discharges, autism diagnoses quadrupled over a ten-year period. The authors also note that rates of autism and ADHD diagnoses peak at ages seven and twelve.
The Diagnosis Controversy
Much has been made of the rising autism diagnosis rates in recent years, especially among those who feel the disorder is being over-diagnosed as well as among those who still cling to the thoroughly debunked autism-vaccine link hypothesis. For me, rising rates are easily explained with two basic variables:
- Better Definitions. Prior to 1994, there was no formal criteria for diagnosing Asperger Syndrome, nor was autism considered to have a high end to its spectrum. This eliminated the possibility of diagnosis for a large population of individuals on the spectrum. Because the definition was widened, more individuals would be identified, plain and simple.
- Better Funding. Acknowledging the current tightening of special education’s metaphorical belt in recent years, school intervention programs are better staffed and more thoroughly trained than they have historically been. On top of this, more general education teachers have a stronger background in special education. More and better eyes are looking for those who need help, and those who would have previously been swept aside or simply lost in the shuffle are now receiving the services they need.
Think about it with something more obviously physical. If a new working definition of legal blindness was introduced that changed the central vision acuity measurement in the better eye from 20/200 to 20/150, suddenly diagnoses of blindness would skyrocket – not because more people are being born with the disorder or because something in the water is causing blindness. The definition is simply widened, allowing more to fall under the umbrella.
While there may be case for over-diagnosis, as is the danger with any disorder that manifests itself in ways measured against social-cognitive norms, explaining the rise in pervasive developmental disorders such as autism simply falls to a better understanding. I would assert, however, that there is one more variable encouraging greater and faster diagnoses.
The Changing Classroom
Think about a stereotypical elementary classroom in the 80s. I grew up in the 80s, if you have no imagination, so I can help out a bit. You had rows of self-contained, front-facing desks upon which you filled out your individual worksheets/workbooks or read your individual books. About the most social thing that happened in the classroom was if the teacher had students read from the textbook round-robin. Social time was constrained to lunch and recess where few adults supervised many children in an atmosphere of controlled chaos where those experiencing difficulties with social relationships could be easily lost in the shuffle. Perhaps some social anxiety could be spotted during Show-and-Tell.
Contrast this to a modern classroom where collaborative work is strongly encouraged, where children are likely to be sitting at tables facing their peers. In this classroom, children actively perform research and present findings to their class. They engage in reader’s theater and participate in class plays or presentations. Social interaction and peer cooperation is an essential part of their learning experience. How much more obvious would a child with a social-cognitive disorder appear in this setting?
Remember the findings of Mandell’s study – that the highest concentration of autism diagnoses come at ages seven and twelve? In a school setting, you could alternatively say that most diagnoses happen during first and sixth grade. If a child attends a Reggio or Montessori influenced elementary school, autism symptoms will be very visible during that fist year of social acclimation and peer interaction – especially in states that do not fund early childhood education. Then, if the elementary is a more traditional setting, the more self-directed and socially-centered structure of middle school will again make those symptoms plain.
It almost seems too obvious, but there it is, another possible reason more autistic children are being identified. Classrooms of the past would have hidden our friends on the spectrum, but the way classrooms have restructured over recent years will bring social-cognitive challenges to the fore. The signs are easier to see in this setting, leading to more chances to help earlier in childhood development.