A Review of the California Department of Disability Services: The December, 2005 Report
(Click on graph to make larger)
The Department of Disability Services (DDS) has published their quarterly report (DDS, 2006). In that report the numbers of service categories the DDS provides services for are listed. These reports are issued once every quarter. It has become habit for various persons to review these reports for autism and to chart the number of supposed new cases and compare to the number of supposed new cases at the same time, the last year (Rollens, 2006). Various blogs have also featured this topic at different points (Autism Diva, 2005)
The purpose of the current review is to provide a graphical display of these number and justification for this presentation. It is also to provide criticism for the way these numbers have been displayed in the past. It is finally, to provide a discussion for what these numbers indicate.
Figure 1. Shows the prevalence per 10,000 for ages 3-5 according to the DDS. The trend is an increase. This is relevant as it shows that the numbers of autistic children ages 3-5 is still increase according the DDS. This was calculated by comparing the number of children ages 3-5 receiving services for autism from the DDS to the 2000 census for California for ages 0-4. This does not match up perfectly with the DDS group 0f 3-5, but is the best that can be done for the moment. However, any variation in this would not alter the fact that the numbers of 3-5 years old receiving services for autism are still on the rise, both between quarters and years.
Figure 2. Shows the change in the increase from the past quarter from December, 2002-December, 2005. The pattern here is primarily one of instability. There is no immediately recognizable trend, nor does this appear to be a cyclical pattern. I have added an additional line to show the mean, (Mean = 134; Standard Deviation = 50).
The DDS data have been presented and analyzed in a manner that I argue, is erroneous. It has been the practice of some to use the total data presented in these reports as opposed to the data specific to the youngest children ages 3-5 (Rollens, 2006). I will note that some data exists for autism for ages 0-3 in the DDS reports, but very few children seem to receive services at that age.
The problem in using the total data is that only a portion constitutes the 3-5 age groups. When one presents the total data, they are also presenting on adults receiving services. This is an inaccurate practice. Also, some, such as (Rollens, 2006) analyze this as increase by year. This is unfortunate as is glosses over the instability that exists between quarters within a year. By missing this, some have failed to observe that the observation of a slow, downward trend is inaccurate. In addition the claim by Rollens (2006) that change in numbers are new intakes explicitly violate the DDS recommendations that the change between periods, not be counted as new cases (DDS, 2005).
Others have informally asked that the 6-9 ages groups be analyzed as this group may receive booster shots and regress. I criticize this; because to meet criteria for Autistic Disorder (American Psychiatric Society, 1994) the child’s must have shown the same traits by age 3. This means we can diagnose a person who is older than 3, if there history suggest that these traits were present by that time. In fact, the only spectrum category that will allow for this is Childhood Disintegrative Disorder (CDD), in which the child has typical development for the first two years following birth followed by a regression no later than age 10 (APA, 1994). CDD, has a stable prevalence rate at .2 per 10,000 (Fombonne, 2003).
The concept that a child could regress (possibly following a booster shot) anecdotally, does seem to occur. However, such children I have hard of, had been diagnosed as meeting criteria for Autistic Disorder. The concept that a child could suddenly turn autistic from a booster shot has no precedent in the literature. I would guess that such a regression would merit the categorization of CDD (as they would be excluded from any other diagnostic label), yet that prevalence rate is stable.
By calculating the autism prevalence post year 2000, from data taken from (Fombonne, 2003) I find a mean prevalence of 23 per 10,000. To calculate prevalence based on the most recent DDS quarterly report (December 2005) and the 2000 census projections for ages 0-4, I find a prevalence of 22 per 10,000. This is an insignificant difference. This implies that the DDS who only provide services for those who meet criteria for Autistic Disorder seem to be servicing the number of children in the 3-5 age range we would expect. It is important to note that this is not the case during other recent quarters where we should have expected that rate as well.
It is quite possible that this increase in children receiving services will continue to go up and will exceed the mean prevalence rate. This is, because the DDS are gatekeepers for services in California and individuals must meet criteria for Autistic Disorder, if they will receive services. It is quite possible who meet criteria for PDD-NOS are deliberately mis-diagnosed by DDS diagnosticians so that they are eligible to receive services.
To conclude; Rollens (2006) asks “For those who continue to believe in the fantasy that we have NOT experienced an epidemic of autism, might I ask one simple question: If the incidence of autism hasn't increased dramatically over the past 20 plus years, then where are all the adults with full syndrome autism? Surely if there is no real increase then we should see roughly the same number of adults with autism as we do children. I am sure it is about as easy today, as it has been in the past, to somehow misplace or not recognize thousands of adults with full syndrome autism...about as easy as missing a train wreck. Sorry but no Ph.D. or MD required to recognize either one.)”
I note that the above argument has an illogical statement by stating that any counter statement is “fantasy” before the argument is ever given. This technique provides ridicule in an attempt to distract from any legitimate argument that may be given. To answer the question itself one can review the DDS data and observe an increase in the older age groups as well. While this may be in part provided by movements into California, I note that the 3-5 year old bracket is also not controlled for such. This means there may be some parity between them in this regard. These adults were very likely receiving services under another category of the DDS. I propose that many persons who are autistic are still receiving services under such categories. This is logical considering that before 1980 autism was not a formal category in the DSM and that in 1994 the diagnostic criteria were altered. This is analogous to what is seen with the IDEA numbers, as has been observed (Laidler, 2005).
To equate Autistic Disorder to a train wreck in terms of being unmistakable is a false equation and is an error of logic. For such equations, even a single counter example can show the inaccuracy of the argument. I have personally helped diagnose a teenage boy with Autistic Disorder, who was formerly diagnosed only with Mental Retardation. Perhaps, even the MDs and PhDs are not always the diagnosticians we would wish for. How such as these would be expected to make a diagnosis that was not yet a formalized category would also be a question that merits an answer.
I would expect that portion of these older persons would be re-diagnosed into the autism category in spite of the earlier category they would have been placed in. I note, that an increase of older persons is in fact noted.
Notes: A special thanks to Ginger at Adventures in Autism for generously providing a portion of the data used in this analysis. Ginger’s blog can be found at http://adventuresinautism.blogspot.com/
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Association; 1994.
Autism Diva. Monday, July 11, 2005. http://autismdiva.blogspot.com/ Accessed October 6, 2005Autism Diva. Friday, April 22, 2005. http://autismdiva.blogspot.com/ Accessed October 6, 2005
Department of Disability Services (2006). Quarterly Client Characteristics Reports.
Accessed Friday January 13, 2005
Department of Disability Services (2005). Data Interpretation Considerations and Limitations.http://www.dds.ca.gov/FactsStats/pdf/CDER_QtrlyReport_
Accessed Friday January 13, 2005
Fombonne, E. (2003). Epidemiological surveys of autism and other pervasive developmental disorders: an update. Journal of Autism and Developmental Disorders. 33, 365-382.
Laidler, J. (2005). US Department of Education data on "autism" are not reliable for tracking autism prevalence. Pediatrics, 116 (1), 120-124.
Rollens, R. (2006) California Reports: New Autism Cases at 4 Year Low. Schafer Autism Report, 10 (7). Thursday, January 12, 2006, http://www.sarnet.org/
Accessed Accessed Friday January 13, 2005
State of California, Department of Finance, Population Projections by Race/Ethnicity, Gender and Age for California and Its Counties 2000-2050, Sacramento, California, May 2004.
Taylor, G. (2006). Adventures in Autism. California Autism Numbers 4th Quarter 2005
Thursday Januray 12, 2006 http://tinyurl.com/88b6z.
Accessed Friday January 13, 2006