Increased autism diagnosis: rising incidence or improved recognition

¶ … Autistic Children Being Born Increasing or Were They Always There?

Autism Spectrum Disorder (ASD) is a neurological disorder which is defined by the National Institute of Mental Health (NIMH) (2015) as "the name for a group of developmental disorders. ASD includes a ... spectrum, of symptoms, skills, and levels of disability." The spectrum of conditions include a range of potential common characteristics, including unusual and/or repetitive behavioural traits, problems associated with communicating and interacting with other people, and symptoms which may adversely impact on an individual's ability to function socially (NIMH, 2015). The condition appears to manifest in children from all ethnic backgrounds, although research of Kogan et al. (2009), indicates that prevalence of the condition has a high incidence in certain populations. Firstly, gender with reports that boys are four times more likely to have ASD compared to girls (Kogan et al., 2009). The National Institute of Neurological Disorders and Stroke (2016), also identified this bias in manifestation, and a greater prevalence in male rather than female children. Kogan et al., (2009), also found that non-Hispanic black children were 57% less likely to have ASD compared to non-Hispanic white children, and non-Hispanic multicultural children were 42% less likely to have ASD compared to non-Hispanic white children. The severity of the condition also varied, with 49.6% of parents describing the symptoms as mild (Kogan et al., 2009). 33.9% of children were classified as presenting moderate symptoms, and 16.5% is severe, with no significant difference in severity level and assessed by gender or sociodemographic factors, other than children classified as suffering severe effects were more likely to have parents with less than 12 years of education, accounting to 68% of the sample.

These results indicate be possible to argue there are biological influences, especially with the impact of gender and ethnic origin on the potential manifestation of ASD . However, sociodemographic factors, such as parental educational levels also better. Importantly, when examining the data, it may also be considered that when examining sociodemographic factors, there are other potential variables related to these are considering economic utility, ethnic minorities often suffering from social demographic problems, such as lower levels of income, and the associated lifestyle issues.

A key issue in managing or treating any condition is the ability to diagnose the condition. There is little doubt that the numbers of children diagnosed with ASD have increased (Newschaffer, F, & Gurney, 2005). The question for many medical professionals today, is whether the occurrence of autism is increasing, or whether the rise diagnosis is simply due to a greater level of recognition, as well as a possibility for over diagnosis.

Methodology

This brief research paper will be based secondary data gathered from existing peer review journals and official sources, such as the CDC. The topic is one that is difficult to assess, as the identification of under diagnosis in the past is problematic, due to the historic nature of data. Therefore, the research methodology employed will be based on a pragmatic approach, utilising an inductive research paradigms. The inductive, rather than deductive approach is suitable due to the complex nature of the problem, and acceptance there may be more than a single answer, which is aligned with an interpretivist rather than a positivist epistemology (Saunders, Lewis, & Thornhill, 2012). It is more usual within medical, and scientific research in general, to adopt the positivist paradigms, associated with a deductive, rational approach (Furtak, Seidel, Iverson, & Briggs, 2012). However, to provide the required characteristics of research; validity and reliability (Cresswell, 2013), in a robust manner, the research would be required to undertake a vast level of data collection in order to analyse trends in data. With many different views, potential for sociodemographic influences, as well as changing environment, the pragmatic research paradigms facilitates a more flexible approach (Saunders et al., 2012). Therefore, methodology employed aims at providing some generalisable results, which may provide a basis for further research.

The research in this paper based on an extensive literature review, using secondary information to assess the changes in prevalence levels, and identify potential explanations for those changes, and examine these explanations in any statistical results primary research which may support, or undermine, the potential for other variables impacting on increased levels of autism. If new variables are not discovered that may explain how and why autism is increasing, it is more likely that the influences are not causing the right, it is that the diagnostic processes are improving. Therefore, in addition to considering potential causes would increase autism, diagnostic procedures may also be considered.

Discussion and conclusion

Examining the results, it appears that there are some biological influences that may be the result of environmental exposure. However, there is no solid evidence to support the potential impact of environmental factors after birth. Importantly, despite this absence of evidence, the hypotheses still remain, there is also no proof excluding these influences, so it is possible they may have an impact on the rising level of ASD. There is a greater level of evidence supporting the idea of prenatal influences, which is also supported by biological development theories, especially as the brain is developing during early pregnancy, and research and autism is a neurological disorder, which is also associated with some chromosomal characteristics.

However, while environmental factors may have some influence, there is also very persuasive arguments indicating the apparent changes in diagnostic criteria impacting on a higher level of diagnosis. Diagnosis is often undertaken with reference to a set of symptoms, with the current framework being DSM V. This potential change in diagnostic levels is not limited to only autism, the ability to utilise diagnostic criteria as the major tool to identify conditions has been seen in other conditions. Most recently, the research of King & Bearman (2009) indicated that there may have been and overdiagnosis in the past, as the most recent framework reduced, rather than increase the level of diagnosis. Likewise, the study in Denmark clearly identified peaks in diagnosis associated with periods when there was a change in the diagnostic criteria.

In conclusion, it appears there are likely to be numerous, and complex, reasons behind the increasing level of ASD. While a significant level may be the result of changes in diagnostic criteria, which may be helping to identify those with the condition more easily than in the past, this does not mean there are no other influences. The potential for biological developmental processes to be compromised by maternal exposure have also been demonstrated. Importantly, there are also likely to be factors which remain unidentified, or unproven, which may also include more environmental influences which are based on an ongoing basis. Therefore, it is highly likely there are many influences impacting on the increased level of ASD diagnosis, but it may not be attributed completely to either an increase in the prevalence due to environmental factors, or just the diagnosis procedures.