Autism a Public Health Problem
Autism is a serious public health problem which impacts many children. According to a recent report from the Centers for Disease Control, 1 out of every 150 American eight-year-olds has some form of autism. The previous estimate was one in 166 children. This suggests that 560,000 children in the US have autism. The reason for the high percentage of autism remains unclear. The CDC is now conducting a study to try to identify the environmental factors associated with autism. Research has shown no differences based on race, ethnicity, or socioeconomic status in either the prevalence or incidence of autism in children. Although, the condition does not seem to differ in percentage by culture or race; diagnosis and treatment disparities do exist.
Healthcare Disparities and Autism
African-American children frequently are confronted with late diagnoses or misdiagnosis, according to the National Early Intervention Longitudinal Study done under a grant from the US Department of Education. The study suggests this may be due to evidence that African-Americans are less likely than Whites to see the same pediatrician over an extended period of time. A pediatrician who sees a child regularly over time may recognize autism sooner than those exposed less frequently at office visits. The study encourages African American parents to ask many questions and be persistent in getting their health care provider to diagnose autism related concerns.
In a study done by David Mandell and Dr. John Listerud entitled, Race Differences in the Age at Diagnosis Among Medicaid-Eligible Children with Autism, African-American children with autism are diagnosed nearly two years after children of all other ethnic groups and they received more misdiagnoses than Whites. They also found that minority families and families with lower incomes or limited education had more difficulty entering the early intervention system for autism. Early intervention is critical for better outcomes. Advocating for vigilant diagnosis, treatment and education about this condition among the African American community can help lessen the disparity.
What is Autism?
Autism is a brain disorder that is connected to a variety of developmental problems, in communication and social interaction. The first signs of autism usually appear before age 3. Although there is no cure for autism, it is a treatable lifelong condition. The key feature of autism is impaired social interaction.
According to the Mayo Clinic, children with autism have problems in three crucial areas of development — social skills, language and behavior. The most severe form of autism is evident by a complete inability to communicate or interact with other people.
Often it is the parent that notices their child has symptoms suggestive of autism. Amy Higgins-Boyd, a Behaviorist that specializes in autistic children states, “Typically, they describe their infant child as showing little interest in others and having difficulty with changes in routines or their environment. A child with autism may appear to develop normally and then withdraw and become unresponsive to social contact. Often children with autism engage in repetitive movements such as rocking and twirling, or in self-abusive behavior such a head-banging.” Higgins-Boyd also states the importance of joint attention as an important indicator. Joint attention behaviors represent a critical area in typical development, emerging between the ages of 9 and 15 months. Joint attention skills have been found to be related to receptive and expressive language skills among typically-developing children. Joint attention is important for the development of other skills as children age, such as more expressive language and symbolic play.
The National Institute of Neurological Disorder and Stroke (NINDS) report that Autism (sometimes called “classical autism”) is the most common condition in a group of developmental disorders known as the autism spectrum disorders (ASDs). Other ASDs include Asperger syndrome, Rett syndrome, childhood disintegrative disorder, and pervasive developmental disorder.
What about Vaccines? Are they safe?
Vaccinations given to children have been suggested by some Americans to cause the onset of autism. This has primarily been linked to the fact that the characteristics of autism coincide with the timing of vaccinations. The measles, mumps and rubella (MMR) vaccine in particular is most often singled out as the culprit. The Centers for Disease Control and Prevention, the Institute of Medicine and the American Academy of Pediatrics all contend that vaccines including the MMR vaccine do not cause autism.
How is Autism Diagnosed?
According to NINDS, when doctors diagnose autism they look for the following behaviors using a screening instrument to gather information about a child’s development and behavior:
- impaired ability to make friends with peers
- impaired ability to initiate or sustain a conversation with others
- absence or impairment of imaginative and social play
- stereotyped, repetitive, or unusual use of language
- restricted patterns of interest that are abnormal in intensity or focus
- preoccupation with certain objects or subjects
- inflexible adherence to specific routines or rituals
Upon recognition of autistic behaviors treatment and early intervention can be conducted. Autism is a complex disorder, so it requires a diverse team to diagnose and treat the condition. Often diagnoses and treatment includes a neurologist, psychiatrist, speech therapist, and other professionals .If your child exhibits behaviors characteristic of autism make certain you are relying on a multi-disciplinary team to diagnose and treat your child.
What does the research about autism provide?
Researchers believe that gene studies will help unlock the mystery of autism. In a study done by National Institutes of Health, the National Alliance of Autism Research, the Hussman Foundation and the Autism Genetic Resource Exchange analyzed 54 African American families and 557 Caucasian families in which a member had autism. Researchers studied the genes that regulate a brain chemical or neurotransmitter called GABA along chromosome 15. Chromosome 15 has been linked to autism. According to the researchers, GABA slows down nerve cells once their message has been transmitted to the brain acting as an information filter that prevents the brain from becoming over-stimulated. If the GABA system fails, the brain can be flooded with sensory information that overpowers the brain's processing capabilities, leading to some of the characteristic behaviors of autism.
The largest research for autism genes to date, funded by the National Institutes of Health (NIH), has implicated components of the brain's glutamate chemical messenger system and a previously overlooked site on chromosome 11. Based on 1,168 families with at least two affected members, it adds to evidence that tiny, rare variations in genes may heighten risk for ASDs. Among the new clues is stronger evidence for an association between autism and sites of genes. Continued genetic discoveries in this area will unleash the autism mystery and hopefully provide more research for curing this disease.
- Be persistent with your doctor if you suspect your child has autism
- The key research institutions do not believe autism is caused by vaccinations
- Learn as much as you can about autism and pass it along to others. Early intervention is critical.
- If your child exhibits autistic behaviors ask many questions and make sure a multi-disciplinary medical team is helping you identify the problem.
- Autism Society of America: http://www.autism-society.org/
- The National Institute of Neurological Disorders and Stroke (NINDS): http://www.ninds.nih.gov
- National Institute of Mental Health: Autism Spectrum Disorders (Pervasive Developmental Disorders): http://www.nimh.nih.gov/healthinformation/autismmenu.cfm
- Centers for Disease Control: CDC Releases New Data on Autism Spectrum Disorders (ASDs) from Multiple Communities in the United States, February 8, 2007
- Racial Inequity in Special Education, 2002, Daniel J. Losen & Gary Orfield, Editors, Cambridge, MA: Harvard Education Press.
- Largest-Ever Search for Autism Genes Reveals New Clues National Institutes of Health, February 18, 2007: http://www.nimh.nih.gov/press/largest-ever-search-for-autism-genes-reveals-new-clues.cfm
- Interview: Amy Higgins-Boyd, Behaviorist, Sacramento, CA
- Mayo Health Clinic: www.mayoclinic.com
Kimberly Higgins-Mays MPH, MBA