Why did autism rates soar? Look at diagnoses, not vaccines

Autism rates increased 60-fold in the last 30 years, but not because of vaccines or environmental toxins, writes psychiatrist Allen Frances in a New York Times op-ed. Changes in diagnosis criteria added children with milder, more common symptoms.

Sheldon Cooper, the genius physicist on "Big Bang Theory" appeared to have Aspberger's Syndrome.

Frances led the American Psychiatric Association’s task force charged with creating the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. In the third edition of the DSM, published in 1980, "autism was tightly defined and considered extremely rare," he writes. "Criteria for the diagnosis required a very early onset (before age 3) of severe cognitive, interpersonal, emotional and behavioral problems."

His task force expanded autism-related diagnoses to include Asperger’s disorder, Frances writes. Nobody realized what would happen. Autism diagnoses increased from one in 2,500 children to one in 150 in a decade, and kept climbing. Now one in 31 children receives an autism diagnosis.

That includes "many instances of overdiagnosis — children were labeled with a serious condition for challenges that would better be viewed as a variation of normal," he writes. "It also sowed the seeds of conspiracy theories and anti-vaccine beliefs."

I researched the rise in autism diagnoses years ago, in my newspaper days, and found large-scale studies in different countries that show no link between vaccinations and autism. Whatever policies developed countries adopt -- more vaccines, different vaccines, fewer vaccines -- the rates of autism kept going up.

"No known environmental factor" can explain the the rise in diagnoses, writes Frances. The DSM changes can.

Many parents saw children with an autism diagnosis receive more services in school and pushed for the same help, he writes. There's no clear line between mild autism and social awkwardness or eccentricity. Things got even fuzzier in 2013, when the fifth update of the DSM "eliminated Asperger’s disorder as a stand-alone diagnosis and folded it into the newly introduced concept of autism spectrum disorder."

Social networking popularized the "epidemic," and encouraged more people to be labeled autistic, he writes. "Some people turn to the diagnosis as a way to feel less shame and guilt around social awkwardness or difficulties in juggling tasks."

Labeling oneself "neurodivergent" has become popular: 19 percent of Americans, and 30 percent of adults under 30, "identify" as neurodivergent when it's defined as an "umbrella term for people whose brains work in an atypical fashion," including autism, ADHD and learning disabilities." Everyone wants to be special.

A diagnosis is helpful to some people, but can hurt others, Frances warns. Futhermore, "overdiagnosing autism also often misallocates very scarce resources away from the more severely impaired people who most need them."

I live in Silicon Valley where at least half the techies probably could warrant an Aspie diagnosis. My nephew, diagnosed in kindergarten in the '90s, doesn't stand out among his fellow programmers. He's normal abnormal for that line of work.

Severe autism is a very different issue, and, as Frances writes, we need serious research to understand it and treat it.