No Epidemic of Autism
Edward R. Ritvo, MD Friday, April 30, 1999[Dr. Ritvo (ERitvo@aol.com) is a well-known figure in the world of autism research and was an early critic of the works of Dr. Ivar Lovaas, also of UCLA -ls
THERE IS NO EPIDEMIC OF AUTISM! Rather my research efforts to identify mild forms of the disease which began in the 1970s is paying off. We now diagnose a spectrum of severity ranging from the "classical" Kanner description of the most sever cases to the mildest forms called "Asperger's Syndrome (all of which have "AUTISTIC DISORDER DSM IV).
Also, increased case finding is mainly due to: a) Our efforts to educate physicians and the public as to the nature of autism so that more accurate diagnoses are made and cases are identified. b) The availability of public agencies and schools to provide services in the community and thus keep tabs on newly - properly diagnosed cases. c) The closure of State and private "warehouses" where many were improperly diagnosed, and housed.
The prevalence figures that are emerging just now from California and Illinois are in line with recent figures from Japan and other countries that have recognized the existence of milder cases of autism for several years, Thus, the increased figures (up to 25 - 30/10,000) come as no surprise to those following the international epidemiological literature.
Edward R. Ritvo, MD, Professor Emeritus, UCLA Medical School
The trouble with Ritvo's success is that we don't know much about the adaptive success of these kids being diagnosed with his "mild" form when they grow up. I think my cohort at East Patterson Memorial High in New Jersey had about a 75% prevalence of such mild forms, because that was how many out of the 35 kids tracked together on the basis of IQ got scholarships and eventually doctorates of some kind. I hope we are not convincing kids with such narrow interests as paleontology, astronomy, physics, mathematics, and chemistry that these is something wrong about their obsession to learn everything about their subject (to the exclusion of sports and hurting other kids in preparation for military service). I guess at the present time, we feel that an obsession with learning is pathology, something to be discouraged actively, as opposed to letting children go on as far as they can as long as it is genuine interest, constructive, and building on itself. I think that we have to remember that to a bit over half the population who have IQs less than 100, those with IQs in the 95th percentile and above all seem pretty odd, especially if they apply themselves in a really focused manner.
This why my own interests in ASD have always involved finding ways that might help children with low IQs accelerate their rate of learning, and when applied to ASD, with those low IQ kids too. Slow learning, the cumulative deficit in which such children fall behind their peers more and more each year, has seemed to me the crippling developmental disability that most needs to be addressed. And while things are looking a bit up for effective intervention in recent years, most of the affected children still just can't be helped to accelerate their learning rate significantly. In the end, perhaps it comes down to deciding where we should devote scarce resources; toward a scary word, no matter how carefully we apply it, or to something that can result in a sustainable victory over an otherwise inevitable deeply unsatisfactory outcome.