Who Let Michelle Dawson Have a Blog?

I just stumbled onto Michelle Dawson’s blog by way of Autism Diva.

Michelle will have a way to put her ideas out there in a broader format. Hopefully one that can allow for broader assessment. This may lead to greater acceptance or greater denial of her ideas. This will be interesting to watch.

46th Skeptic's Circle

Left Brain....Skeptics...Right Brain....I like the sound of that.

Anyway, go see what Kev hath made http://www.kevinleitch.co.uk/wp/?p=449

A Review of Mr. Rollens’ Latest Interpretation of CDDS Data.

Rick Rollens periodically reviews the autism data from the California Department of Disability Services (CDDS). He often issues these interpretations in the Schafer Autism Report.

Mr. Rollens is not alone in using the CDDS data. Geier & Geier (2006); and Croen, Grether, Hoogstrate, & Selvin (2002) have also made use of these data. Many bloggers have also analyzed these data, including myself.

This issue also pops up in the journalistic sense from time to time. David Kirby has made specific claims about a decrease that must occur by 2007. His goose might soon be cooked, unless he shifts his goal posts.

CDDS has noticed this and gone on record mentioning that their data are not to be used for incidence and prevalence studies as there would be numerous random and systematic errors that are not controlled for in their data,which are really only meant to be an executive database, something to summarize for state legislatures and other interested parties who State funds are being used for more or less.

This is not a problem unique to the CDDS. It also present in the US special education data (Laidler, 2005; and Shattuck, 2006) and pointed on this blog here, here, here, and here.

In the past I have reviewed Mr. Rollens’ comments. His latest commentary has just come to my attention. He makes several specific interpretations that I think are worth discussion. In this post I will review these claims and talk about fallacies and data errors that were committed within his analysis.

Mr. Rollen’s writes:

“According to data just released by the California Department of Developmental Services (DDS), during the 3rd. Quarter of 2006 (August through September), California added 841 new cases of autism to it's developmental services system, a number that represents the second highest quarterly reported number of new cases in the system's 37 year history.”

That position should be contrasted to his position in January of this year which asserted that CDDS autism cases were at a four year low. This is a rapid shift from first to third quarter. This is more problematic when one considers his arguments at that time that CDDS autism cases were in general, headed down.

However, a problem emerges here in that Mr. Rollen’s uses all the autism data across ages, not merely the youngest children ages 3-5 which the average age of diagnosis (Jick, Beach, & Kaye, 2006). Autism must be fist evidenced by age three, even if diagnosis occurs later (APA, 1994). So, any older persons who enter the CDDS system, must also have met criteria by age 3 and were simply missed, or moved, or were already in the system and receiving services for another category.


Of course, since the CDDS is service based system, even if someone was diagnosed and entered the system in one quarter it is entirely realistic that because of paper work traffic that they might not be included on any official counts for some time.
This means that there are inherent threats to the accuracy of any attempt to use these data for incidence or prevalence calculation. Specifically a previous analysis on this blog found that the CDDS data were susceptible to all six types of random and systematic statistical errors.

(click on graph to make larger)

Figure 1. shows what the 3-4 year old CDDS autistic data looks like. Although I give all the data going back to 1992, I calculated the mean of the quarterly reports beginning in the first quarter of 2000 and extending to the Lanterman Act revisions in that took effect in August 2003. I did this to keep the years relatively recent.I repeated this process for
The data following the Lanterman Act revisions which happens to coincide with a supposed downturn in the number of new cases.

The data are (133; 95% Confidence Interval = +/- 31) for the former and (139; 95% Confidence Interval = +/- 29) for the latter. The mean differences are minor indeed and are well within confidence intervals.

Mr. Rollens writes:

“In 1987 there were 2,778 cases in the system, by the end of 2002 the number had increased to 20,377, and today there are 31,853 persons with autism in the system.”

By which he means persons as young as 0 years of age or as old as 80+. But again, when one looks very broadly across age groups, it is difficult to know if a increase is meaningful in terms of people newly developing autism. There is an excellent graph of “prevalence” to be found here.

Mr. Rollens writes:

“Over 84% of all persons with autism in California's system are between the age of 3 and 21. 88% of the autism population currently live at home.”

Which is of course rather intuitive, many people under 21, do in fact live at home. This might be nearly all of people 18 years of age or younger. However, this is an interesting point for another reason. In informal conversation, I report often hearing that some parent would be forced to give their child up due to their autism. And that if a child is not cured this is the inevitable result. If these data have any validity, then apparently that is false.

Mr. Rollens writes:

“INCREASING RATE SLOWS DRAMATICALLY

In 1999, DDS released it's now famous and historic autism caseload report that documented a 273% increase in the number of new cases of autism entering California's developmental services system from 1987 through 1998.

In 2003, DDS followed up with an updated report that documented a 97% increase in the autism caseload over the 48 month period from December 1998 through December 2002.

ACCORDING TO DDS, DURING THE MOST RECENT 45 MONTH REPORTING PERIOD FROM JANUARY 2003 THROUGH SEPTEMBER 2006, THERE HAS BEEN A 50% INCREASE IN THE AUTISM CASELOAD. THE RATE OF INCREASE HAS DECLINED BY NEARLY HALF OVER THE PREVIOUS LIKE REPORTING PERIOD. THE RATE OF INCREASE HAS SLOWED BY CLOSE TO HALF FROM 97% TO 50% DURING THE PAST 45 MONTHS.”

Simply said; Mr. Rollen’s analysis is discrepant from the data in the 3-5 age cohort.

Mr. Rollens writes:

“while the younger, 3-9 year old cohort reflects the substantial, declining rate of increase as noted above.”

Again, this is not what the data show. Returning to Figure 1., the pattern if anything, is one of instability.

Mr. Rollens writes:

“Reasons for this phenomenon could include the lessening burden of mercury in vaccines slowing the numbers of new young children entering the system, a tightening of eligibility criteria that took effect in July 2003 (see last paragraph), and Regional Centers responding to the pressure to qualify more older persons with higher functioning autism spectrum conditions.”

An yet a third time, the 3-5 year old cohort is not showing a decrease. This seemingly invalidates any theories for a cause of such. I am reminded of an excellent comment from Gernsbacher, Dawson, and Goldsmith (2005) "Epidemics solicit causes; false epidemics solicit false causes." With apologies to the authors I would like to offer a corollary: The end of false epidemics solicit causes; the false ends of false epidemics solicit false causes.

Mr. Rollens writes:

“One thing is for sure, the hidden hordes of adults with autism that needs to be accounted for in order to discredit the existence of an autism epidemic and an increasing incidence of autism have yet to come forward or be discovered.”

Mr. Rollens is partially correct. He is right in the sense that we have not found a “horde”, but oft and again we find older person 40+ years of age who we now diagnose as autistic.

Also, I am concerned how strongly the burden is now shifted to those who would ask for better proof to accept an “epidemic of autism”. This is in fact, shifting the burden of proof.

All this said, I would argue that evidence is amassing that would refute the theory of an thimerosal based epidemic. I note the equivelance of of the prevalence rate of autism for the US (Bertrand, Mars, Boyle, Bove, Yeargin-Allsop, & Decoufle, 2001), the UK (Chakrabarti & Fombonne, 2005), Canada (Fombonne, Zakarian, Bennett, Meng, & McLean-Heywood, 2006), and the Faroe Islands (Ellefsen, Kampmann, Billstedt, Gillberg, & Gillberg, 2006), this is despite the differences of vaccination schedule and type in those nations.

Also, Chakrabarti & Fombonne (2005) showed that 2 cohorts were equivalent; one of the cohorts was born the early 1990s and the other was born in the mid 1990s. This is significant as these groups should have split the difference we see in Figure 1., and yet they were equivalent. In the past I have gone so far as to collate a list of research which does not support an autism epidemic.

At the close of my last response to Mr. Rollens I posed a question. I will pose it again now: What is the validity of using the California DDS data when the CDDS has stated that they should not be used for this purpose and when they do not resemble other existing epidemiology?

References

American Psychiatric Association. (1980). Diagnostic and Statistical Manual ofMental Disorders, Third Edition. Washington, DC: American Psychiatric Association; 1980.

American Psychiatric Association. (1987). Diagnostic and StatisticalManual ofMental Disorders, Third Edition, Revised. Washington, DC: American Psychiatric Association; 1980.

American Psychiatric Association. (1994). Diagnostic and StatisticalManual ofMental Disorders, Fourth Edition. Washington, DC:American Psychiatric Association; 1994.

American Psychiatric Association. (2000). Diagnostic and Statistical Manual ofMental Disorders, Fourth Edition, Text Revision. Washington, DC:American Psychiatric Association; 1994.

Bertrand, J., Mars, A., Boyle, C., Bove, F., Yeargin-Allsop, M., & Decoufle, P. (2001). Prevalence of autism in a United States population: the Brick Township, New Jersey, investigation. Pediatrics, 108, 1155-161.

Chakrabarti, S., & Fombonne, E. (2001). Pervasive developmental disorders in preschool children. Journal of the American Medical Association, 285,3093-3099.

Chakrabarti, S., Fombonne, E., (2005). Pervasive developmental disorders in preschool children: confirmation of high prevalence. American Journal ofPsychiatry, 162(6), 1133-1141.

Croen, L. A., Grether, J. K., Hoogstrate, J. and Selvin, S. (2002). The Changing Prevalence of Autism in California. Journal of Autism and Developmental Disorders. 32, (3), 207-215.

Department of Developmental Services (2006). Quarterly Client Characteristics Reports.http://www.dds.ca.gov/FactsStats/quarterly.cfmAccessed Friday October 20, 2005.

Department of Developmental Services (2005). Data Interpretation Considerations andLimitations.http://www.dds.ca.gov/FactsStats/pdf/CDER_QtrlyReport_ Consideration_ Limitations.pdfAccessed Friday January 13, 2005.

Ellefsen, A., Kampmann, H., Billstedt, E., Gillberg, I. C., Gillberg, C. (2006). Autism in the Faroe Islands. An Epidemiological Study. Journal of Autism and Developmental Disorders. [Electronically published ahead of print]

Fombonne, E. (2002). Prevalence of childhood disintegrative disorder (CDD). Autism 6, 2, 147-155.

Fombonne, E. (2003). Epidemiological surveys of autism and other pervasive developmental disorders: an update. Journal of Autism and Developmental Disorders. 33, 365-382.

Fombonne, E. (2001). Is there an epidemic of autism? Pediatrics.Vol 107 (2), 411-412.

Fombonne, E., Zakarian, R., Bennett, A., Meng, L., McLean-Heywood, D. (2006). Pervasive developmental disorders in Montreal, Quebec, Canada: Prevalence and links with immunizations. Pediatrics. 118(1) 139-150.

Friis, R. H., Seller, T. A. (2004). Epidemiology for public health practice, 3rd ed. Sundbury, MA: Jones and Bartlett Publishers.

Gernsbacher, M.A., Dawson, M, & Goldsmith, H. H. (2005).Three reasons not to believe in an autism epidemic. Current directions in psychological science, 14 (2), 55-58.Honda, H., Shimizu,

Y., Imai, M., & Nitto, Y. (2005). Cumulative incidence of childhood autism: a total population study of better accuracy and precision. Developmental Medicine And Child Neurology. 47(1), 10-8.

Jick H, Beach KJ, Kaye JA. Incidence of autism over time.Epidemiology. (2006). Epidemiology, 17(1), 120-121.

Laidler, J. (2005). US Department of Education data on "autism" are not reliable for tracking autism prevalence. Pediatrics, 116 (1), 120-124.

Mandall, D. S., Novak, M. M., Zubritsky, C. D. (2005). Factors associated with age of diagnosis among children with autism spectrum disorders. Pediatrics,Vol 116 (6), 1480-6.

Shattuck, P,T. (2006). The Contribution of Diagnostic Substitution to the Growing Administrative Prevalence of Autism in US Special Education. Pediatrics, (117) 1028-1037.

Schafer Autism Report, 8, 165. Wednesday, October 20, 2004, http://www.sarnet.org/Accessed Accessed Friday February 4, 2005.

United States Census Bureau. (2006). Personal Communication.

Respect Meme: 5 Simple Questions

This project is a "two sides of the coin" type of thing. It was done jointly with Maria. Her answers to this meme are here. If anyone else wants to tackle this meme, post a comment and I will post a link to your answers on this page.

Other bloggers who took a stab at it are Ian and Not Mercury, so go check 'em out.


1 What is respect for others?

Respect for others is:

A) The avoidance of questioning of motive and the avoidance personal attacks.

B) Trying to attack the most charitable interpretation of another’s argument as possible.


2 What are things that appear to respect issues, but are not?

The big thing here is the argument. Some people can not separate the argument from their personhood. Mocking an argument and or dissecting it is not the same as disrespect for a person.


3 Is this relevant to the autism discussion and why?

Yes, very relevant. The respect issue has had a profound effect on the autism world. The bitterly felt implication that parenting caused autism helped guide us away from a “learning” based etiology of autism and towards a biologic/genetic view. It is also what partially colors the modern question of whether autism is caused by vaccines and whether medical officials know this.


4. What can we do to help resolve these issues?

Try to accurately and charitably define others positions and arguments. Also, the recognition that emotional investment/depth doesn’t equal a good or valid argument.

5. How well do you think this will be accomplished?

Very poorly indeed. I think that, people will continue to look for ill-motivation in others or accuse others of being liars, or naïve, when they offer opposing arguments.

Interverbal: Where This Blog is Headed

The recent birthday of this blog prompted me to think about where this blog has been and where it is headed. In the last year it has become evident that there is a level of readership here, which I did not expect or plan for. For a short time recently I wondered if now was the right time to stop posting to Interverbal and focus solely on my research and professional activities.

After some thought, I decided that this point hasn’t come yet and that I still had many projects I would like to do on this blog. I composed a comprehensive list of projects that I intend for the future both near and far.

Some of these will be controversial with some folks e.g. (#6, 7, 8, 10, 22), however, hopefully good discussion will arise from such.

1 Respect Meme: 5 Simple Questions. 1 day

2 A Review of Rick Rollins Latest. 3 Days

3 The Return of Dr. Seuss Inspired Epidemiology Poetry. Late November

4 A Description of Autism Related Testing. Early December

5 At the Bar with B.F. Skinner. Christmas

6 A Review of Chomsky’s Critique of Skinner’s Verbal behavior. New Year’s Day

7 A Review of Facilitated Communication Literature. Late January

8 A Look at Autism Advocacy. Winter

9 New Autism Fallacies. Winter

10 A Review of Informed Consent. Spring

11 At the Bar with Freud. Distant Future

12 At the Bar with Jung. Distant Future

13 At the Bar with Carl Rogers. Distant Future

14 Book Review of “The Empty Fortress”. Distant Future

15 Book Review of “Infantile Autism”. Distant Future

16 Book Review of “Dibs: In Search of Self”. Distant Future

17 Book Review of “Children with Emerald Eyes”. Distant Future

18 Book Review of “Early Childhood Autism”. Distant Future

19 A Comparison of Early Autism Criteria. Distant Future

20. A Listing of Behavior Analytic Autism Articles. Distant Future

21 A review of GF/CF Diet Literature. Distant Future

22 A Look at Where Autism has Been and Where it is Going. Distant Future

How Do You Solve a Problem Like Maria?

[For the initiated in the joys of wholesome family musicals the title refers to a song in “The Sound of Music”]

Maria, is a PhD chemist at a university in Argentina. She is a mother to an autistic child. She is also a voracious reader and disseminator or autism based research. And is usually quite thorough in expressing her ideas.

Maria has taken the time to discuss and debate with many of us on the autism hub even though we are usually on opposite sides of the fence. Occasionally, even appearing on this blog.

Her band new blog can be found at http://www.searchingequilibrium.blogspot.com/

Skeptic's Circle Time

45th Circle is up in a kind-of-sort-of podcast style.

116.1 in 10, 000 or 1 per 86

Please have a look at this recent study:

“BACKGROUND: Recent reports have suggested that the prevalence of autism and related spectrum disorders (ASDs) is substantially higher than previously recognised. We sought to quantify prevalence of ASDs in children in South Thames, UK. METHODS: Within a total population cohort of 56 946 children aged 9-10 years, we screened all those with a current clinical diagnosis of ASD (n=255) or those judged to be at risk for being an undetected case (n=1515). A stratified subsample (n=255) received a comprehensive diagnostic assessment, including standardised clinical observation, and parent interview assessments of autistic symptoms, language, and intelligence quotient (IQ). Clinical consensus diagnoses of childhood autism and other ASDs were derived. We used a sample weighting procedure to estimate prevalence. FINDINGS: The prevalence of childhood autism was 38.9 per 10,000 (95% CI 29.9-47.8) and that of other ASDs was 77.2 per 10,000 (52.1-102.3), making the total prevalence of all ASDs 116.1 per 10,000 (90.4-141.8). A narrower definition of childhood autism, which combined clinical consensus with instrument criteria for past and current presentation, provided a prevalence of 24.8 per 10,000 (17.6-32.0). The rate of previous local identification was lowest for children of less educated parents. INTERPRETATION: Prevalence of autism and related ASDs is substantially greater than previously recognised. Whether the increase is due to better ascertainment, broadening diagnostic criteria, or increased incidence is unclear. Services in health, education, and social care will need to recognise the needs of children with some form of ASD, who constitute 1% of the child population.”

The older criteria used in the study produced a lower rate of autism which was just outside the confidence intervals (margin of error) for the newer criteria. This is an extremely important finding which has implications for how diagnsotics contributes to autism prevalence. I am surprised the authors did not address this more directly.

Baird, G., Simonoff, E., Pickles, A., Chandler, S., Loucas, T., Meldrum, D. & Charman, T.(2006). Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP). The Lancet, 368, 210-215.

On Bernard Rimland

Dr. Rimland is a man I have many philosophical disagreements with. I oppose his theory of the etiology of autism, I oppose the way he justified that theory, I oppose the way he has defended the theory. I disagree with his treatments, and I dislike the way he has defended those treatments. Finally, I disagree with the view he has promoted of autistic people.

It might come as no surprise if I were to therefore say that I have ill feeling toward him.

Not so however. Yesterday I learned that Dr. Rimland was ill, possibly very seriously. I hope very sincerely that he will recover and remain with us for some time to come and if not, that he will be remembered for his dedication to the autism field and his important early work debunking the refrigerator-mother etiology of autism theory.

Autism in the Faroe Islands

I was directed to this today:

1. Ellefsen, A., Kampmann, H., Billstedt, E., Gillberg, I. C., Gillberg, C. (2006). Autism in the Faroe Islands. An Epidemiological Study. Journal of Autism and Developmental Disorders. [Electronically published ahead of print]

The rate of .56% of the population translates to 56 per 10,000. This is well within the margin of error as the rate in the US, Canada, and the UK (60 per 10,000).

This is a “genetically distinct population” in a northern Europe. Their diet consists mostly of meat, including mutton, fish, and whale meat/blubber. Whale meat is known to be extremely mercury heavy.

This is reminiscent of in terms of fish and even whale meat intake to:

E, Fombonne., J, Morel., J, Macarthur. (2006). No Autism Amongst Inuits From Northern Quebec. Paper Presented at IMFAR. June, 2006.

Except that Fombonne et al. found no autism in Inuit population (which is also genetically distinct), but who have excellent health care including full vaccines. It was argued the Inuits (a closed population) may have developed a natural and high, self-chelation ability. Unfortunately this is not shown by any research and it is a dogmatic fallacy, almost a Lamarckian fallacy, to claim that because it would make sense for a population to develop a given trait, that they actually have.

This may not be a "nail in the coffin", but it is defiately getting harder and harder to ascribe the potential "epidemic of autism" to mercury.

Purely Anecdotal: Proud of the FDA

Go check out Kathleen’s post which has the FDA response to a civilian petition concerning thimerosal or mercury based preservatives.

Polite, logical, direct, clear headed, and as well written and referenced as an academic paper.

Thank you Dr. Shuren for the time this would have taken to research, consider, and write. I truly think that it is worth it. Even if this hadn’t been in favor of what I think, I would have been impressed by the depth here.

I am proud of the FDA's effort in this regard.

Happy Birthday Interverbal: One Year Later.....

18,584 unique visitors; not bad for a grad student’s blog that was started for the purpose of practicing writing/thinking skills.