There is discussion that ASD is being found at earlier ages and there is discussion that ASD is manifesting itself at earlier ages.

Nowhere have I found a discussion concerning the changes in our cultural treatment of children during the early school ages. It is well known that adult ASD is very hard to diagnose because adults have learned to camouflage their symptoms well over the years. I feel that this camouflage technique reaches much farther down the age scale than many realize.

However, our cultural emphasis on social conformity has shifted in the past few decades. Might this be one of the reasons we are recognizing more ASD youngsters? They aren’t being pushed to conform (camouflage) as much as were those in the 1950 through 1980 generations.

Just a thought from an ASD, in his 70th decade.

Pops

“For the first two decades after Kanner’s first paper, people considered autism and intellectual disability to be distinct. So, people with ID were not diagnosed autistic. How is that the same as today”?

You obviously didn’t bother to read Kanners paper. His complaint that was that the “mentally defective children with bizarre behaviors” were being diagnosed as ‘Autistic’. Diagnostic substitution was going on then as it is now.

What would reading Kanner’s first paper have to do with this? Did he predict how diagnostic trends would go for the next two decades?

The statement I made was based on an old review paper which, in turn, cited a paper from 1966.

“When Kanner (1943) first described the diagnostic features, he also remarked that the bore no resemblance to any known neurological condition and implied that autistic children had basically normal intelligence. For over two decades afterwards, diagnosticians generally believed that the presence of mental retardation or neurological signs ruled out the diagnosis of infantile autism in the Kannerian sense, even if the child met all behavioral criteria (Eisenberg 1966)

If you want to take this up with the author of the review, or with Eisenberg, feel free.

Regarding orphanages, I’m not so sure that extreme social deprivation during critical timeframes couldn’t have profound and real neurological defects; probably in some cases resulting in behaviors consistent with autism. Several animal models of social deprivation show neurological, behavioral, and neuroimmune similarities to what is seen in autism. Conversely, also in animal models, an enriching environment has been shown to have protective effects at a neurological level.

Lets assume that what we call autism today is way too broad and is only useful because we cannot apply sufficient subtlty to our observations to avoid over generalizations. What then? What are your thoughts on helping to alleviate this problem?

– pD

You obviously didn’t bother to read Kanners paper. His complaint that was that the “mentally defective children with bizarre behaviors” were being diagnosed as ‘Autistic’. Diagnostic substitution was going on then as it is now.

The paper by Patricia Howlin’s group demontrates how diagnostic substitution is still alive and well since the association with ASD in the genetic syndromes have only a superficial association with ASD because they may share a number of isolated secondary symptoms with other people with structural brain anomolies.

Adult stroke patients have also been found as a group to have social-communication impairments with Theory of Mind and executive function impairments. Are adult stroke patients also on the spectrum?

The number of studies which have found that Romanian Orphans abandoned at birth and suffering horrendous conditions in the snake-pit orphanages in Romania meet diagnostic criteria for ASD using Gold Standard diagnosis tools (AUT-R):

http://www.ncbi.nlm.nih.gov/pubmed/16167089?

Rutter has called these children ‘Quasi-Autistic’ children. This is nothing new. In his 1965 paper noted that Crewel coined a new term ‘pseudo-autism’ just like Rutter has in coining the term ‘Quasi-autism’ in reference to the Romanion children. And it can’t be forgotten that the Romanian orphans met diagnostic criteria for autism using Gold Standard diagnostic tools, which says a lot more about the validty of Gold Standard diagnostic tools than it does about ‘Quasi-autism’ or the superficial ASD symptoms present in genetic syndromes.

Kanner’s comments on ‘pseudo-autism’:

To complicate things further, Crewel, in the hope of avoiding confusion between true autism and other conditions with autistic-like features, suggested the term pseudo-autism for the latter. Even this term came to be employed haphazardly, and conditions variously described as hospitalism, anaclitic depression, and separation anxiety were put under the heading of pseudo-autism.

If you consider Romanian orphans to be on the ‘Autism Spectrum’ then you might agree that severe early emotional deprivation can cause ‘Autism’ which should bring Bettleheim back into the conversation. The Gold Standard diagnostic tools that are admired so much says so, doesn’t it?

wrong study RAJ. You are thinking of the pediatrics paper that came out a few months ago.

While Kanner used politically incorrect labels, the comparison with current conceptions of ASD definition is the same.

For the first two decades after Kanner’s first paper, people considered autism and intellectual disability to be distinct. So, people with ID were not diagnosed autistic. How is that the same as today?

A new interesting study looked at genetic syndromes associated with ASD (Fragile X, Tuberous Sclerosis, Angelman Syndrome, PKU among them) and found that the ASD symptoms are superficially related to ASD and cautioned about how to interpret ASD rates within the genetic syndromes as the rates of ASD in genetic syndromes are directly related to the severity of mental retardation.

http://www.ncbi.nlm.nih.gov/pubmed/19708861?

Dignostic substitution is not a new phenomena. Kanner in 1965 also reported on diagnostic substituion that had occurred over a 20 year period since the publication of his original article in 1943.

He wrote in 1965:
“Moreover, it became a habit to dilute the original concept of infantile autism by diagnosing it in many disparate conditions which show one or another isolated symptom found as a part feature of the overall syndrome. Almost overnight, the country seemed to be populated by a multitude of autistic children, and somehow this trend became noticeable overseas as well. Mentally defective children who displayed bizarre behavior were promptly labeled autistic”

While Kanner used politically incorrect labels, the comparison with current conceptions of ASD definition is the same.

http://neurodiversity.com/library_kanner_1965.html

Both then and now, a superficial association with ASD symptoms explains diagnostic substitution, or as Kanner would have called it ‘Misdiagnosis’.

Lorna Wing actually had suggested prevalence might be closer to 1% even earlier, but this was basically an extrapolation from various different findings. Her intuition proved correct.

About incidence vs. prevalence, see the Wikipedia article for an explanation of the concept. The “incidence” of autism is probably 1 in 10,000 per year. Actual incidence is indeed difficult to measure, simply because you don’t know date of onset. You just know date of diagnosis or date of inclusion in a database.

But the issue of undercounting is not an incidence vs. prevalence issue. That’s a misconception. There can be administrative prevalence and administrative incidence, both inaccurate.

Change the subject, let us try a prevalence survey for people with an IQ above 120. Well what datum do we start from.

I would wager with the flyn effect that is something you could never do, my present IQ is bound to be greater than Einsteins measured IQ, because of that cos if he were alive and tested today, well who knows because it is all an artefact.

We still do not know what it is we are measuring to take a base line from. I don’t give a fig for gold standard ADOS, because my generation is not todays generation and culture undlerlines it all, we don’t even know what tommorows disorders will be other than that they will be.

Until we can find a bio marker it is always going to be speculative. I don’t think the biomarker is there myself, autism is something that you know when you see it, but you can’t properly define.

We do need to look at a bigger picture, because the very construction of autism is multifaceted, and each of those facets leads to another set of possibly linked conditions.

We don’t even agree what language is yet in order to define a language disorder as a subset from it.

Science is still in it’s infancy, and unfortunately the direction of science is toward many threads rather than the link between them, it is increasingly difficult for any specialist to have sufficient of a general education in science to even know what others are doing.

Prevalence means nothing unless we are looking at other “co-morbities” to use the jargon, and then we could plot some very pretty diagrams.

Gillberg perhaps was on the right track years ago (heck Hawkwind has just entered my mind, I’ll be off on one soon)

Gillberg is quite a smart cookie really and a pioneer of this whole epidemiology business.