Published online April 3, 2006
PEDIATRICS Vol. 117 No. 4 April 2006, pp. 1436-1437 (doi:10.1542/peds.2005-2834)
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COMMENTARY

Investigating Diagnostic Substitution and Autism Prevalence Trends

Craig J. Newschaffer, PhD

Department of Epidemiology, Center for Autism and Developmental Disabilities Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Abbreviations: MR, mental retardation

The first 20% of the full text of this article appears below.

In this issue of Pediatrics, Dr Shattuck presents findings from his intensive statistical analysis of diagnostic substitution in US special education data.1 Diagnostic substitution is one factor potentially contributing to the large observed increase in autism prevalence and, unlike many other possible factors, empirical evaluation of this factor can actually be approached by using existing administrative data. However, analyses of this sort are not without their challenges and complexities. When considering diagnostic substitution in US special education data, we are limited to group-level comparisons. We do not know whether individual children have switched classifications, and of course we can never know whether a given child in a particular birth cohort would have been classified differently had they been born either earlier or later. At best, analyses of this type are merely trying to determine if trends in one classification have the potential to offset those in another.

Although Shattuck's models incorporate a number of advantageous features, they essentially distill the assessment of this . . . [Full Text of this Article]

Address correspondence to Craig J. Newschaffer, PhD, Department of Epidemiology, Center for Autism and Developmental Disabilities Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Room E6030, Baltimore, MD 21205. E-mail: cnewscha@jhsph.edu


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