Should We Be Concerned? Autism Diagnoses Continue To Skyrocket

Autism diagnoses have surged, now affecting 1 in 36 children, due in large part to increased awareness, earlier screening, and broadened diagnostic criteria. Experts note that improved detection methods and an evolving understanding of the autism spectrum have played key roles in the rise of reported cases.

Autism diagnoses have risen with better awareness and broader definitions. Experts say it’s a sign of improved detection, not just more cases.

Autism diagnoses have risen sharply in recent decades, shifting from a relatively rare condition to one now affecting 1 in 36 children.

This significant increase has sparked national discussion, including remarks by former President Donald Trump during a joint address to Congress. Trump said “not long ago” cases were only “1 in 10,000,” perhaps referring to a 1970 study by Darold A. Treffert.

While the rise has raised concerns for some, experts at Northeastern University emphasize that improved awareness, broader diagnostic criteria, and earlier screening are key factors driving the higher numbers.

After all, they say, much is still being learned about autism, which was only officially recognized by Congress as a disability in 1990.

Public awareness and understanding

“I think this reflects a healthy trend of increased public awareness and also increased understanding and societal awareness of autism,” says Zhenghan Qi, a Northeastern University assistant professor of communication sciences and disorders and psychology.

“The biggest change is that we’ve gotten much better at screening and identifying kids,” says Laurel Gabard-Durnam, director of Northeastern’s PINE (Plasticity in Neurodevelopment) Lab.

In addition, “We’ve changed the criteria for what it means to have autism,” she says. “We’ve since acknowledged that it’s a spectrum. So some of this is just labeling differences.”

What is autism, and when was it discovered?

Autism is a neurological and developmental disorder that affects how people interact with others, communicate, and learn, according to the National Institute of Mental Health.

First described by Dr. Leo Kanner in 1943, symptoms of autism typically appear in the first two years of life and include delayed language skills, avoidance of eye contact, obsessive interests, and unusual body movements such as rocking or flapping hands.

“Since then, our understanding of what autism is has changed a lot,” says Qi, who directs the Language Acquisition and Brain Laboratory (QLab) and uses neuroimaging to study language development in children with autism.

What are some autism milestones?

Qi says the most recent change happened in 2013, when the Diagnostic and Statistical Manual of Mental Illness, Fifth Edition identified Asperger’s syndrome as a type of high-functioning autism, among other changes.

In addition, clinicians now recognize that people with other disorders can have autism as well as Down syndrome and attention deficit disorder, which further expands the ranks of people with autism, Qi says.

She says the increase in autism numbers can also be attributed to a growing recognition that the disorder occurs among people from different ethnicities and cultures.

“The majority of research before 2000 and in the beginning of the 21st century was mostly from the middle class and white population,” she says.

How are autism cases diagnosed?

There also is heightened awareness that girls as well as boys can have autism, although boys are still four times as likely to receive an autism diagnosis.

The researchers say inherited genetic mutations, older parents, and improved survival rates for pre-term babies also contribute to autism rates, but more needs to be understood about the roots causes of the brain disorder.

“Some of the risk factors have changed alongside the fact that we’re doing a better job finding (cases) and screening,” Gabard-Durnam says.

“On the whole, we’re doing a much better job at identifying kids earlier as we get better instruments for doing the screening and as we get a more refined sense of what is worrying and what is not on some of these different measures,” she says.

“With autism, there’s no blood test. There’s not an objective marker. Ultimately it comes down to a human judgment call based on screening criteria,” she says. “So we really depend on physicians and screening centers to identify folks.”

Universal screening recommended

In 2007, the American Academy of Pediatrics recommended universal screening for autism at 18 and 24 months so that children could receive the type of early intervention services that can make a difference in their education and lives.

“Screening is increasingly becoming standardized,” Gabard-Durnam says. “It will depend a bit on your state. One reason we think we’re doing a better job at identifying folks is we see state level differences in autism prevalence.”

“This tells us in states where they are taking a more uniform approach to early screening we are finding these kids, and in states that are taking a less robust screening approach they are missing individuals,” she says.

Checklist of traits for parents

Screening tools include the M-CHAT-R/F, or Modified Checklist for Autism in Toddlers, Revised with Follow-up, which was based on a test revised in 2009, and the POSI, for Parental Observation of Social Interaction, which was first published in 2013.

Providing a checklist of traits for parents to look for is important because it leads to children getting services at an early age that will help them succeed in school and in life, Qi says.

“Early intervention is absolutely the key,” she says.

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