# How did autism become the latest fad disorder? **URL:** \ **Category:** Cecil's Columns/Staff Reports\ **Created:** [March 30, 2014, 4:32pm UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909 "2014-03-30T16:32:33Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![padebafey](https://avatars.discourse-cdn.com/v4/letter/p/3bc359/32.png) [@padebafey](https://boards.straightdope.com/u/padebafey)\ **Post date:** [March 30, 2014, 4:32pm UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909/1 "2014-03-30T16:32:33Z")
I don’t know which was more uninformed/offensive…the question or the answer. Clearly, there’s a very good reason it’s taking longer to fight ignorance than you thought. ---
**Author:** ![Captain\_Amazing](https://avatars.discourse-cdn.com/v4/letter/c/6de8d8/32.png) [@Captain\_Amazing](https://boards.straightdope.com/u/Captain_Amazing)\ **Post date:** [March 30, 2014, 5:12pm UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909/2 "2014-03-30T17:12:10Z")
Hi, and welcome to the Straight Dope Message Board. Generally, if you’re talking about a column, it helps to include a link to it so other people can know what you’re talking about. So, here’s a link to the column so that people can talk about it. > **[How did autism become the latest fad disorder?](https://www.straightdope.com/21344245/how-did-autism-become-the-latest-fad-disorder)** ---
**Author:** ![TimeWinder](https://avatars.discourse-cdn.com/v4/letter/t/bcef8e/32.png) [@TimeWinder](https://boards.straightdope.com/u/TimeWinder)\ **Post date:** [March 30, 2014, 5:22pm UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909/3 "2014-03-30T17:22:21Z")
It’s also traditional when saying you disagree with something, to say _why_. The column seems pretty straightforward to me. (Except that it’s out of date by the time it’s printed. The lastest “fad disorder” is currently “gluten sensitivity.”) ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [March 30, 2014, 5:43pm UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909/4 "2014-03-30T17:43:04Z")
It’s only going to be a matter of time before all children will be assumed to be autistic until proven otherwise. :dubious: It’s been that way in some circles with ADD/ADHD for quite some time. It’s also the only disability I’ve ever seen or heard of for which many of the victims’ mothers seem to think the world revolves around them because of it. Guess what. It doesn’t. ---
**Author:** ![Amateur\_Barbarian](https://avatars.discourse-cdn.com/v4/letter/a/59ef9b/32.png) [@Amateur\_Barbarian](https://boards.straightdope.com/u/Amateur_Barbarian)\ **Post date:** [March 30, 2014, 5:47pm UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909/5 "2014-03-30T17:47:01Z")
Maybe because the odds of having a child with autism have gone from an estimate of 1:100,000 to 1:10,000 to 1:100 to (current) about 1:62. It’s also a disorder with very little effective treatment past about 3 or 4, so early diagnosis and intensive intervention are critical. There is no waiting until later to try and fix things, as far too many parents find out. ---
**Author:** ![Stranger\_On\_A\_Train](https://avatars.discourse-cdn.com/v4/letter/s/13edae/32.png) [@Stranger\_On\_A\_Train](https://boards.straightdope.com/u/Stranger_On_A_Train)\ **Post date:** [March 30, 2014, 6:03pm UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909/6 "2014-03-30T18:03:19Z")
To be clear, the breadth of autistic spectral disorders (ASD) has been expanded with the increased recognition that some people who were previously just considered “off”, “have poor social skills”, “no discipline”, “acting out”, or otherwise stigmatized actually suffer from an affliction which makes it difficult for them to control their behavior or interact socially without extra training and conditioning, and that all of that behavior falls upon a spectrum from completely non-functional and requiring institutionalization to moderate difficulties with interactions but can be a productive and functional human being. The spectrum of disorders are clustered together (along with Asperger’s Syndrome) because the methods of treatment are essentially the same. Yes, it was much easier in decades past when we could just mock people for being awkward and not grasping social cues, or institutionalize those whose impairment and lack of training makes it impossible for them to hold a job, but it would be nice to think that we’ve come to understand the variety of the human condition and are willing to make allowances for those who weren’t innately born with social graces and a natural ability to read body language. This isn’t to say that the condition isn’t often misdiagnosed by people who are not qualified to assess ASD pathology, but it is clear that there is a far larger population of afflicted people than previously considered, and many can be helped by early intervention and training. As for ADHD, it is also clear from both the literature and wide experience that there is an increased awareness of it as a condition which prevents effective study or attentional focus, which was previously and ineffectually dealt with by humiliation, punitive exercises, and corporal punishment bordering on or extending into physical abuse. I personally suspect (and there is considerable research to hypothesize that) much of this is due to the ways in which we now educate and socialize children, including overstimulation via televisions, toys, and computers such that normal “slow” interactions don’t provide enough stimulation to keep a student engaged. This probably extends to adults as well, a hypothesis you can validate for yourself by spending a couple of weeks away from modern civilization or in a foreign country where you can’t speak the language and don’t have access to the usual entertainments, and then return to find how fast everybody else moves and speaks. So I suspect at least some component of the increase in ADHD diagnosis isn’t just the previous lack of understanding the nature of the issue but also environmental stimulus which tends to exacerbate the condition. That it has also become a “fad disorder” to explain all manner of ills does not discount the reality of an increase in awareness by trained diagnosticians. Stranger ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [March 30, 2014, 6:26pm UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909/7 "2014-03-30T18:26:30Z")
> [@nearwildheaven](#): > > It’s only going to be a matter of time before all children will be assumed to be autistic until proven otherwise. :dubious: It’s been that way in some circles with ADD/ADHD for quite some time. What “circles” would those be, circles in which all children are assumed to be ADHD until proven otherwise? ---
**Author:** ![Amateur\_Barbarian](https://avatars.discourse-cdn.com/v4/letter/a/59ef9b/32.png) [@Amateur\_Barbarian](https://boards.straightdope.com/u/Amateur_Barbarian)\ **Post date:** [March 30, 2014, 7:48pm UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909/8 "2014-03-30T19:48:18Z")
The rise in autism cases is far, far greater than changes in diagnosis. The formal and working diagnoses keep shifting around and there are a half-dozen closely related syndromes that exist more to differentiate insurance responsibility and publications than real variations in the affliction. But no one questions that the overall occurrence has skyrocketed in recent decades, and there is still no accepted understanding of a cause. ---
**Author:** ![TimeWinder](https://avatars.discourse-cdn.com/v4/letter/t/bcef8e/32.png) [@TimeWinder](https://boards.straightdope.com/u/TimeWinder)\ **Post date:** [March 30, 2014, 7:53pm UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909/9 "2014-03-30T19:53:46Z")
> [@Amateur\_Barbarian](#): > > But no one questions that the overall occurrence has skyrocketed in recent decades, and there is still no accepted understanding of a cause. I question it, and so do most neural researchers I know. It was one of the big reasons for the push to change the DSM to stop continually broadening the definition. There’s actually very little good evidence that actual instances are increasing, as opposed to better diagnosis, greater parental awareness, and a greater willingness to classify almost any personality variation as part of the spectrum. ---
**Author:** ![tapu](https://avatars.discourse-cdn.com/v4/letter/t/49beb7/32.png) [@tapu](https://boards.straightdope.com/u/tapu)\ **Post date:** [March 30, 2014, 8:58pm UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909/10 "2014-03-30T20:58:46Z")
Whoa, dude, why didn’t you just come in wearing a sign saying, Punch Me I Deserve It? Flirted with any education or sensitivity lately? Get your feet wet in some research. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [March 30, 2014, 9:05pm UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909/11 "2014-03-30T21:05:51Z")
> [@Ambivalid](#): > > What “circles” would those be, circles in which all children are assumed to be ADHD until proven otherwise? For a start, kids from low income and/or single parent families. Until around 2000, at least here in the Midwest, it appeared to be diagnosed only in Caucasians. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [March 30, 2014, 9:08pm UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909/12 "2014-03-30T21:08:39Z")
> [@Stranger\_On\_A\_Train](#): > > As for ADHD, it is also clear from both the literature and wide experience that there is an increased awareness of it as a condition which prevents effective study or attentional focus, which was previously and ineffectually dealt with by humiliation, punitive exercises, and corporal punishment bordering on or extending into physical abuse. Some people still feel it should be treated this way. Folks, ADHD is NOT about violent, antisocial behavior! A child who is setting fires, killing animals, acting out sexually as a preteen, etc. may have ADHD, but that is not why they’re acting that way. ---
**Author:** ![Chronos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chronos/32/134_2.png) [@Chronos](https://boards.straightdope.com/u/Chronos)\ **Post date:** [March 30, 2014, 9:35pm UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909/13 "2014-03-30T21:35:48Z")
The biggest problem, I think, is people self-diagnosing (or diagnosing their children or students) with autism disorders (or ADHD, or gluten sensitivity), rather than getting a real diagnosis from a doctor. If you think (as many people do) that ADHD just means “would rather play video games instead of doing homework”, or that autism means “sometimes doesn’t get along very well with other people”, then of course you’re going to see it everywhere. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [March 30, 2014, 10:47pm UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909/14 "2014-03-30T22:47:56Z")
> [@Chronos](#): > > The biggest problem, I think, is people self-diagnosing (or diagnosing their children or students) with autism disorders (or ADHD, or gluten sensitivity), rather than getting a real diagnosis from a doctor. If you think (as many people do) that ADHD just means “would rather play video games instead of doing homework”, or that autism means “sometimes doesn’t get along very well with other people”, then of course you’re going to see it everywhere. Just as bad are people who take their kids to 10 or 15 doctors until they find that one who will diagnose the kid, no questions asked. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [March 30, 2014, 11:57pm UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909/15 "2014-03-30T23:57:41Z")
Many _many_ people, especially experts, question “that the overall occurrence has skyrocketed in recent decades.” There is no question that much of the explosion has been more diagnosis and not more incidence. It is impossible right now to tell how much is which. That does not mean that all the additional diagnosis is inappropriate diagnosis, even if it results in labelling kids who two decades ago would just have been called “odd.” Does it communicate concisely the behaviors that the child likely manifests and accurately predict some possible future issues, both strengths and weaknesses? Does it suggest some approaches that have been useful to others who also fit that label, approaches that help the child function better and that help avoid difficulties within a family and within a school environment? Then call it a disease, a disorder, a difference, or neurodiversity, the label is _useful_ and identifying the child earlier so those effective interventions can be implemented earlier is worthwhile. No question that _many_ people now identified as high functioning autism or Asperger Synrome would not have been so identified a few decades back. I’d argue that the increase though is often (not always) _better_ diagnosis, not exclusively diagnostic creep, and helping most of those children function better both short and long term. ---
**Author:** ![Amateur\_Barbarian](https://avatars.discourse-cdn.com/v4/letter/a/59ef9b/32.png) [@Amateur\_Barbarian](https://boards.straightdope.com/u/Amateur_Barbarian)\ **Post date:** [March 31, 2014, 12:27am UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909/16 "2014-03-31T00:27:25Z")
> [@DSeid](#): > > Many _many_ people, especially experts, question “that the overall occurrence has skyrocketed in recent decades.” Cite one who isn’t a celebrity. While you’re at it, cite anything from the CDC that isn’t extreme alarm at the skyrocketing rate - their term, not mine. > [@](#): > > There is no question that much of the explosion has been more diagnosis and not more incidence. It is impossible right now to tell how much is which. 100% bullshit; I assure you that whoever you’re quoting has no idea what they’re talking about. There are many unknowns about ASD. There is more authoritative data that global climate change is a myth than that the occurrence of autism has not increased by several orders of magnitude in the last decade or two. ETA: Which is to say “not very much.” Just had to make sure. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [March 31, 2014, 1:25am UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909/17 "2014-03-31T01:25:00Z")
[Since](http://ije.oxfordjournals.org/content/38/5/1224.short) [you](http://jama.jamanetwork.com/article.aspx?articleid=195670) [asked](http://pediatrics.aappublications.org/content/117/4/1028.short). [No](http://www.sciencedirect.com/science/article/pii/S1750946710000917) [celebrities](http://onlinelibrary.wiley.com/doi/10.1002/ajmg.c.31325/full) [here](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2927813/) [at all](http://www.ncbi.nlm.nih.gov/pubmed/16919130?dopt=Abstract) > [@](#): > > The odds of a patient acquiring an autism diagnosis were elevated in periods in which the practices for diagnosing autism changed > [@Eric Fombonne](#): > > … it would be tempting to interpret this age trend as indicative of a secular increase in the rate of ASD … such an explanationis both unlikely and biologically implausible … Rather … these differences might reflect new diagnostic criteria for autism and increased availaiblity of developmental disability services for children with autism in the 1990s … comparison of rates over time generally deal with studies that have used different case definitions … > [@](#): > > Prevalence findings from special education data do not support the claim of an autism epidemic because the administrative prevalence figures for most states are well below epidemiological estimates. The growing administrative prevalence of autism from 1994 to 2003 was associated with corresponding declines in the usage of other diagnostic categories. > [@](#): > > One of the most controversial topics with respect to this population is the prevalence of this spectrum of disorders. The number of cases has risen dramatically, and various hypotheses have been put forward to explain this phenomenon. Among the most frequently addressed possibilities are expanded diagnostic criteria, more awareness of the disorder, diagnosis at earlier ages, and the recognition that ASD is a lifelong condition. > [@](#): > > The description and criteria by which autism and autism-related disorders are defined have changed markedly since Kanner’s initial publication in 1943, as has its suspected etiology. In the absence of a gold standard biomarker, however, the diagnosis of any disorder based on behavioral evaluation will be influenced by the apparent manifestation of criteria used to define the disorder. Inevitably, this will impinge upon any epidemiologist’s ability to determine accurately the prevalence and/or incidence of the disorder. Notwithstanding the difficulties regarding definition, assessing the prevalence of any behavioral disorder is fraught with methodological issues: Study design (retrospective or prospective); population sampled and recruited; sample size; cohort age range; public and professional awareness of the disorder; validity, reliability, and stability of criteria used for assessment and case detection; reliability and validity of the screening instrument and/or clinician; the probability model used to construct confidence intervals; all are factors affecting the obtained prevalence of the disorder. As I have attempted to show, prevalence rates for autism have increased markedly in the past half century or so, not so much as a developing epidemic, but as a result of the changing parameters associated with the factors just noted. > [@](#): > > One does not “catch” autism from someone else, yet a social diffusion process contributes significantly to the increased prevalence of autism. We observe a strong positive effect of proximity to other children with autism on the subsequent chance of diagnosis, robust to a range of individual- and community-level controls in both urban and less urban areas. In addition, close proximity to a child with autism was inversely associated with the likelihood of subsequent sole MR diagnosis, while it correlated strongly with the chance of autism-MR diagnosis. Proximity also increases the chance of autism rather MR diagnosis given the same level of severity in autism symptoms. Social influence arises strongly for high-functioning cases of autism. The effect of proximity is also more prominent in younger children, when diagnosis is more difficult and parental resources are more important. Children who were diagnosed with autism have a similar mode of referral as that of their nearest neighbor with autism before their diagnosis. All of these findings are consistent with a mechanism of social diffusion of awareness of the symptoms and the benefits of treatment and are inconsistent with competing explanations. > > Social influence also accounts for the observed spatial clustering of autism. … social diffusion dynamics can affect the chance of a diagnosis. Our finding on the negative effect of proximity to children with autism on subsequent sole MR diagnosis provides a new way to understand the dynamics of diagnostic substitution. … social influence makes sense of the increased prevalence, declining age of diagnosis, and spatial clustering of autism. > [@](#): > > There has (probably) been no real increase in the incidence of autism Oh. Sorry. You asked for just one. Please forgive me. :rolleyes: And [from the CDC](http://www.cdc.gov/ncbddd/autism/research.html): > [@](#): > > It is unclear how much of this increase is due to a broader definition of ASD and better efforts in diagnosis. However, a true increase in the number of people with an ASD cannot be ruled out. The increase in ASD diagnosis is likely due to a combination of these factors. So sure, you can state that a large fraction of the experts in the field, including many of the biggest names, including the CDC, are all spouting “bullshit” when they state that we just cannot know how much is a real increase and how much is more (possibly better) diagnostic labelling but stating that “no one questions that the overall occurrence has skyrocketed” is pure and simply a false statement. Something many would call “bullshit” but me I am not so crude. 🙂 I’m with the CDC on this one. We cannot rule out a true increase but we do not know that there has been one. ---
**Author:** ![Amateur\_Barbarian](https://avatars.discourse-cdn.com/v4/letter/a/59ef9b/32.png) [@Amateur\_Barbarian](https://boards.straightdope.com/u/Amateur_Barbarian)\ **Post date:** [March 31, 2014, 2:04am UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909/18 "2014-03-31T02:04:36Z")
It’s late here so I am going to save a longer response for a later time. However, your cites go as much to contradict your assertion as to support it. For one thing, three are from 2003-2006, which represent interpretations some eight and more years old on data ten to twelve years old and older - an age, if not two ages, in this field. Two others admit the “large increase” right in the abstracts. You seem to be arguing that establishing shifts in diagnosis equates to some invalidation of the numbers. The rise in cases greatly exceeds the number of shifted diagnoses - and in any case, unless you’re going to contend that latter-day diagnoses are the ones in error - are somehow false - it doesn’t matter that 10 or 20 or 50% of these cases were misdiagnosed 10-25 years ago. The number of autism diagnoses has increased at a spectacular rate, and whether it represents a diagnosis shift or some underlying increase in affliction, it is not imaginary or inconsequential. It’s also not a fad disease of the week, diagnosed for some bizarre parental “benefit” as some posters here seem to be implying. It is, however, a magnet for some of the absolutely stupidest things I’ve ever heard responsible adults say in all seriousness. ---
**Author:** ![dropzone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dropzone/32/7515_2.png) [@dropzone](https://boards.straightdope.com/u/dropzone)\ **Post date:** [March 31, 2014, 2:10am UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909/19 "2014-03-31T02:10:39Z")
[QUOTE=Cecil] Those with the syndrome, named after Hans Asperger, the Austrian pediatrician who characterized it in 1944, focus obsessively and lack social skills or empathy. [/quote] Do you know who else was Austrian and in 1944 focused obsessively and lacked social skills or empathy? Sorry, old joke, but it fit without excessive shoehorning. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [March 31, 2014, 3:07am UTC](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909/20 "2014-03-31T03:07:43Z")
**Amateur** You claimed that no experts actually question whether or not the true incidence has “skyrocketed.” The simple fact is that the experts (most of them anyway) rightly state that the rate of autism _diagnosis_ has seen a huge increase but that it is _unknown_ how much of this, _if any_, is based on a true increase in cases versus case finding. We can suspect _some_ is real and speculate why such a hypothetical true increase might occur (my favorite being the assortive mating hypothesis) but we do not know. Your belief of what “I seem to be arguing” evinces a complete lack of comprehension of what I have clearly written. Read in particular [this cite](http://onlinelibrary.wiley.com/doi/10.1002/ajmg.c.31325/full) which was the fifth one given, from 2012, for a recent detailed analysis of why claims of an epidemic are greatly exaggerated. Again, I find great utility in the label. A child (and their family and teachers) benefits from the appropriate label of high functioning autism versus “odd.” There will, predictably, be certain approaches that are likely to work better than others. Certain difficulties that are going to be predictable and anticipated, planned for, looked for and remediated for early on. Certain strengths to anticipate and built off of as well. A toddler with autistic characteristics clearly benefits from early intervention. I am less convinced that the increase of autism as an alternative to or co-diagnosis with the label of metal retardation (or severe global developmental delay) has as much utility, but there is some there as well. One must appreciate however that there is no clear bright line that demarcates those with autism from those who are “normal.” It is not a group over here with “disease” and far away another group who are normal. There is instead a gradual gradient, a spectrum, that goes from those with classic Kanner style autism at one extreme (who once upon a time were all who were labelled such) to those with various degrees of severity to those with mild ASD and very high function and those with Asperger’s and to those with characteristics that overlap with the spectrum but which are in no way disabling, in fact which may actually benefit the individual depending on their vocation and environment, and wider yet into what gets called the [Broad Autistic Phenotype](http://www.jneurodevdisorders.com/content/5/1/11) (who in no way have autism per se) and from there into people who are just socially a bit off. Where the line gets drawn varies depending on who is drawing the line. Comparing rates over time and drawing conclusions about true incidence is impossible and it is that activity, and the consequent false conclusion that there is an epidemic, not the increased labelling itself, that causes the problems that Cecil notes. [Next page](https://boards.straightdope.com/t/how-did-autism-become-the-latest-fad-disorder/684909.md?page=2)