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Rising Autism Could Put
Strain on System
Researchers, Social Workers Concerned About Schools, Social Services
Nov. 27, 2002 -- Diagnoses of autism are increasing at an alarming rate, and the disorder could cause serious strains on social services. Those were the conclusions of researchers, physicians, and patient advocates who attended a meeting of the National Institute of Health's Interagency Autism Coordinating Committee. Autistic patients have trouble with verbal and nonverbal development, usually with delays in language development that can sometimes be quite severe. They also have difficulty with social interactions and tend to stick to limited and repetitive patterns of behavior. Diagnoses are on the upswing. California, for example, has seen a dramatic increase in the number of autistic patients that participate in its social services programs. "Autistic patients have jumped from 3% to 40% in California's developmental services program," says Rick Rollens, of the University of California at Davis-based M.I.N.D. Institute, which is dedicated to autism research and care. It is not clear whether such increases represent a burgeoning epidemic or if mental health professionals are simply more aware of its existence and therefore diagnosing it more frequently. Either way, it seems likely to put a strain on schools and social services organizations in the coming years. The disorder varies widely in its symptoms and severity, with some patients experiencing relatively mild symptoms. Others may have severe impairment of social interactions and language, leaving them virtually speechless. Many of them remain undiagnosed well into adulthood, according to Bernice Polinsky, of AHA/AS/PDD (Advocates for Individuals with High Functioning Autism, Asperger's Syndrome and Other Pervasive Development Disorders). "They're falling through the cracks. They're dropping out of college, they're not getting jobs." Public health officials would like to develop effective screens for autism, because early intervention can improve a patient's quality of life. "[Social interaction] is impaired, but it's not absent," says Helen Tager-Flusberg, PhD, of Boston University's department of psychology. Part of the problem is that autism is poorly understood. It appears to have a genetic component, but exposure to several chemicals also increase risk. Patricia Rodier, MD, professor of obstetrics and gynecology at the University of Rochester, presented the results of a study of these factors. In all cases, the damage appeared to occur in the initial stages of pregnancy, in the parts of the brain that form earliest. If the damage does indeed occur so early in development, it may explain why there are no medications to directly treat the condition. There are plenty of drugs available to treat some of its symptoms, but none that can achieve a cure. That means that autistic patients are likely to stay on medications over long periods of time, raising concerns about side effects that range from mild to serious. One of the more effective drugs, Risperdal, is among the most effective for controlling tantrums, and aggressive and self-injury behaviors that can be associated with autism. In a study published in The New England Journal of Medicine in August, a team led by Benedetto Vitiello, MD, of the National Institute of Mental Health, reported that the drug was effective and well tolerated by autistic patients. Since then, the team has taken some of the patients off of the drug and put them on placebo to see if the beneficial effects continued. Disappointingly, two-thirds of the patients relapsed. "But the interesting part is that one-third did OK without medication," Vitiello tells WebMD. He hopes that future studies will reveal the reason for the difference. Those and other studies should begin to unravel the mystery that is autism. The better we understand it, the better-equipped physicians, teachers, and social workers will be to manage and soften its impact. SOURCES: Rick Rollens, University of California at Davis-based M.I.N.D. Institute • Bernice Polinsky, AHA/AS/PDD (Advocates for Individuals with High Functioning Autism, Asperger's Syndrome and Other Pervasive Development Disorders) • Helen Tager-Flusberg, PhD, department of psychology,Boston University • Patricia Rodier, MD, professor of obstetrics and gynecology, University of Rochester • Benedetto Vitiello, MD, National Institute of Mental Health.
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