PEDIATRICS Vol. 117 No. 4 April 2006, pp. 1028-1037 (doi:10.1542/peds.2005-1516)
The Contribution of Diagnostic Substitution to the Growing Administrative Prevalence of Autism in US Special Education
Waisman Center, University of Wisconsin, Madison, Wisconsin
OBJECTIVE. Growing administrative prevalence of autism has stirred public controversy and concern. The extent to which increases in the administrative prevalence of autism have been associated with corresponding decreases in the use of other diagnostic categories is unknown. The main objective of this study was to examine the relationship between the rising administrative prevalence of autism in US special education and changes in the use of other classification categories.
METHODS. The main outcome measure was the administrative prevalence of autism among children ages 6 to 11 in US special education. Analysis involved estimating multilevel regression models of time-series data on the prevalence of disabilities among children in US special education from 1984 to 2003.
RESULTS. The average administrative prevalence of autism among children increased from 0.6 to 3.1 per 1000 from 1994 to 2003. By 2003, only 17 states had a special education prevalence of autism that was within the range of recent epidemiological estimates. During the same period, the prevalence of mental retardation and learning disabilities declined by 2.8 and 8.3 per 1000, respectively. Higher autism prevalence was significantly associated with corresponding declines in the prevalence of mental retardation and learning disabilities. The declining prevalence of mental retardation and learning disabilities from 1994 to 2003 represented a significant downward deflection in their preexisting trajectories of prevalence from 1984 to 1993. California was one of a handful of states that did not clearly follow this pattern.
CONCLUSIONS. 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.
Key Words: autism • prevalence
Abbreviations: ASD—autism spectrum disorder • MR—mental retardation • LD—learning disabilities • OHI—other health impairments • CDC—Centers for Disease Control and Prevention • OR—odds ratio • TBI—traumatic brain injury • DD—developmental delay
Accepted Aug 18, 2005.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
Related articles in Pediatrics:
- Shattuck PT. The Contribution of Diagnostic Substitution to the Growing Administrative Prevalence of Autism in US Special Education. PEDIATRICS 2006;117:1028–1037.
Pediatrics 2006 118: 852a.[Extract] [Full Text]
This article has been cited by other articles:
|
|
 |
|
  R. F. Palmer, T. Walker, D. Mandell, B. Bayles, and C. S. Miller Explaining Low Rates of Autism Among Hispanic Schoolchildren in Texas Am J Public Health, February 1, 2010; 100(2): 270 - 272. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. D. Kogan, S. J. Blumberg, L. A. Schieve, C. A. Boyle, J. M. Perrin, R. M. Ghandour, G. K. Singh, B. B. Strickland, E. Trevathan, and P. C. van Dyck Prevalence of Parent-Reported Diagnosis of Autism Spectrum Disorder Among Children in the US, 2007 Pediatrics, November 1, 2009; 124(5): 1395 - 1403. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Charman, A. Pickles, S. Chandler, L. Wing, S. Bryson, E. Simonoff, T. Loucas, and G. Baird Commentary: Effects of diagnostic thresholds and research vs service and administrative diagnosis on autism prevalence Int. J. Epidemiol., October 1, 2009; 38(5): 1234 - 1238. [Full Text] [PDF]
|
|
|
|
|
|
N. Nassar, G. Dixon, J. Bourke, C. Bower, E. Glasson, N. de Klerk, and H. Leonard Autism spectrum disorders in young children: effect of changes in diagnostic practices Int. J. Epidemiol., October 1, 2009; 38(5): 1245 - 1254. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. King and P. Bearman Diagnostic change and the increased prevalence of autism Int. J. Epidemiol., October 1, 2009; 38(5): 1224 - 1234. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Zwaigenbaum, S. Bryson, C. Lord, S. Rogers, A. Carter, L. Carver, K. Chawarska, J. Constantino, G. Dawson, K. Dobkins, et al. Clinical Assessment and Management of Toddlers With Suspected Autism Spectrum Disorder: Insights From Studies of High-Risk Infants Pediatrics, May 1, 2009; 123(5): 1383 - 1391. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. T. Parner, D. E. Schendel, and P. Thorsen Autism Prevalence Trends Over Time in Denmark: Changes in Prevalence and Age at Diagnosis Arch Pediatr Adolesc Med, December 1, 2008; 162(12): 1150 - 1156. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E B Caronna, J M Milunsky, and H Tager-Flusberg Autism spectrum disorders: clinical and research frontiers Arch. Dis. Child., June 1, 2008; 93(6): 518 - 523. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Pinborough-Zimmerman, R. Satterfield, J. Miller, D. Bilder, S. Hossain, and W. McMahon Communication Disorders: Prevalence and Comorbid Intellectual Disability, Autism, and Emotional/Behavioral Disorders Am J Speech Lang Pathol, November 1, 2007; 16(4): 359 - 367. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. P. Johnson, S. M. Myers, and and the Council on Children With Disabilities Identification and Evaluation of Children With Autism Spectrum Disorders Pediatrics, November 1, 2007; 120(5): 1183 - 1215. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Williams, A. E. Mars, S. G. Buyske, E. S. Stenroos, R. Wang, M. F. Factura-Santiago, G. H. Lambert, and W. G. Johnson Risk of Autistic Disorder in Affected Offspring of Mothers With a Glutathione S-Transferase P1 Haplotype Arch Pediatr Adolesc Med, April 1, 2007; 161(4): 356 - 361. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E. Brachlow, K. K. Ness, M. L. McPheeters, and J. G. Gurney Comparison of Indicators for a Primary Care Medical Home Between Children With Autism or Asthma and Other Special Health Care Needs: National Survey of Children's Health Arch Pediatr Adolesc Med, April 1, 2007; 161(4): 399 - 405. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Epidemic of Autism? Journal Watch Psychiatry, June 7, 2006; 2006(607): 9 - 9. [Full Text]
|
|
|
|
 |
|
 Epidemic of Autism? Journal Watch Dermatology, May 23, 2006; 2006(523): 8 - 8. [Full Text]
|
|
|
|
 |
|
 Epidemic of Autism? Journal Watch (General), April 25, 2006; 2006(425): 4 - 4. [Full Text]
|
|
|
|
|
|
C. J. Newschaffer Investigating Diagnostic Substitution and Autism Prevalence Trends Pediatrics, April 1, 2006; 117(4): 1436 - 1437. [Full Text] [PDF]
|
|
eLetters:
Read all eLetters
- The obfuscation of the iatrogenic Autism epidemic
- Kenneth P Stoller
- Pediatrics Online, 5 May 2006 [Full text]
- Diagnostic Substitution and ASD: A Brief Comment on Shattuck
- John P. Tuman, et al.
- Pediatrics Online, 19 May 2006 [Full text]
