With the latest CDC figures out, it appears autism is now appearing in about 1 in 68 children in the United States. The disorder — now officially known as autism spectrum disorder — is being diagnosed at a rate that represents a 30 percent increase from 1 in 88 two years ago.
What’s amazing to me is that I couldn’t find a single media report that floated the idea that this increase represents an overdiagnosis of the disorder. While “overdiagnosis” seems to be the first thing suggested when the topic is attention deficit hyperactivity disorder’s (ADHD) huge jump in diagnoses over the past two decades, it’s not mentioned in any description of autism’s increase.
Why the double-standard?
To be clear, I don’t know the answer to the autism question.
While it may indeed simply reflect better diagnosis of the disorder by health and mental health professionals, it may also reflect the same kind of secondary gains garnered by children who get diagnosed with attention deficit hyperactivity disorder (ADHD). Children who get an autism diagnosis — even in its mildest form, what used to be called Asperger syndrome — can get allowances and special consideration in both the academic resources available to them, as well as their academic performance.
Which isn’t to suggest most children who have an autism spectrum disorder diagnosis don’t actually have it. I suspect the vast majority do, and this jump in diagnostic rates is “real.” Children with severe autism need more resources than most children with severe ADHD. But they can both be equally challenging to families. One diagnosis shouldn’t be demonized by the media.
But I would argue that the jump in diagnostic rates of ADHD is also mostly “real,” while some children remain under-diagnosed or under-treated. So why is the jump in ADHD diagnoses attributed to “overdiagnosis” of the disorder, while that suggestion isn’t made in autism?
I’d guess it’s because autism doesn’t have a drug to treat it.1
When journalists can point a finger at “big bad pharma,” it’s easy to raise the specter of “overdiagnosis.” Pharma, it is suggested, is somehow pushing doctors and mental health professionals to diagnose ADHD, just so they can then sell them a drug to help treat it. It’s not entirely clear how pharma is doing this, but that’s the theory.
No such suggestion is being made for autism, and yet the possibility that the increase in autism rates could be partially attributed to overdiagnosis isn’t raised. Overdiagnosis is just as possible with mild forms of autism as it is for mild forms of ADHD, because the presentation relies on subjective symptoms that are present in most children to some degree.
Once a diagnosis is obtained, the child is often then qualified for allowances in their academic performance. Yet I don’t know of any good mainstream media stories that have covered all the secondary (usually academic) benefits children with these kinds of disorders can get.
Autism, like ADHD, remains a serious and often debilitating mental illness that begins in childhood. Both should be treated equally as serious public mental health issues that need to be addressed by policy makers, researchers, clinicians, parents, teachers and advocates. One should not be called-out and demonized for “overdiagnosis” simply because pharmaceutical treatments are available for it.