An explosion in autism cases in California over the past 15 years is not the
result of changes in diagnostic criteria or an improvement in diagnosis, but
represents a real epidemic that is sweeping the state, according to a major
new study sent to the state Legislature on Thursday.
The number of people with autism being served by the California Department of
Developmental Services surged by 273% from 1987 to 1998 -- and is still
growing by about nine cases per day. That increase cannot be explained away by
better data, immigration to the state or any other simple rationale, the
report said.
Experts believe the epidemic is affecting the rest of the country -- and most
industrialized nations -- as well, but California is a bellwether because it
is the only state for which good data are presently available.
"Autism is on the rise in the state and we still do not know why," said Dr.
Robert S. Byrd of UC Davis' MIND Institute, the primary author of the report.
"The results of this study are, without a doubt, sobering. They increase the
urgency of trying to find an answer about what causes autism."
Experts said the report should quell the controversy over whether the epidemic
is real.
"This study will prove to be a landmark in that it clearly dispels many myths
and misconceptions regarding the reality of the widely discussed epidemic of
autism," said Bernard Rimland of the Autism Research Institute in San Diego.
"The epidemic is very real. There has been an enormous increase in the
prevalence of autism, and the increase cannot be explained by artifacts."
The growth of autism cases in California has been startling: from 4,911 cases
in 1993 to 18,460 cases as of July. Of that latter number, 13,935 are children
younger than 18.
The surge in cases forced the department to seek additional funding of $17.2
million this year to treat all of them, according to Cliff Allenby, director
of the Department of Developmental Services. "This is really straining our
resources," he said.
California has been particularly affected by the epidemic because it is
required by state law to provide services to any resident diagnosed with
autism or other mental disorders, Allenby said.
Services in other states "are limited by their budgets," he added. The
increase may well be happening there also, "but they don't see it."
Autism is a severe developmental disorder in which children seem isolated from
the world around them. There are a broad spectrum of symptoms, marked by poor
language skills and an inability to handle social relations. No cure exists,
but many problems can be alleviated with intensive behavioral therapy.
Byrd's three-year study was commissioned by the Legislature after a 1999
report of the 273% increase in autism cases over a decade. During the same
period, in contrast, the department's enrollment of children with other
disorders, such as epilepsy or cerebral palsy, increased 30% to 40%,
consistent with the growth in the state's population.
His team enrolled 684 children who receive services from the department,
dividing them into two age groups 7 to 9 years of age and 17 to 19,
representing the periods before the rise in new cases and after it. The team
found that 375 children had autism and 309 had a diagnosis of mental
retardation.
Comparing the two groups, the team concluded that there had been no loosening
in the criteria used to diagnose autism. Furthermore, more than 90% of the
children in both groups were born in the state, eliminating the possibility
that the increase was the result of families coming to California to seek
better services.
"This is an important first step because it removes the suspicion that things
are changing in terms of diagnoses," Allenby said. "Now it is incumbent on
investigators and us to try to find out why it is happening, because we don't
know yet."
Genetics clearly plays a role. Researchers have so far identified at least
half a dozen genes that predispose people to the development of autism. But
virtually everyone agrees that genes are not the sole answer. "Genes don't
cause epidemics," Byrd said.
Many parents believe that vaccines are at the root of the problem. Some think
the measles-mumps-rubella (MMR) vaccine is the primary villain, some maintain
that a mercury-based preservative in the vaccines is the problem, and others
argue that the 20 or more vaccinations infants receive by the age of 2 simply
overwhelm their immune systems.
But "there is absolutely no evidence for that," according to Dr. Robert
Edwards of UC San Francisco.
