The federal Centers for Disease Control issued its estimates for autism prevalence rates last week, and the numbers, while expected, were staggering nonetheless: One in 88 children in the United States has been identified as having an autism spectrum disorder, the agency now calculates.
That translates into 11.3 autism cases per 1,000 children, a jump of 23 percent over the CDC's data from two years earlier. There were about nine cases per 1,000 using numbers from two years earlier, and eight cases per 1,000 using numbers from four years earlier.
The report comes from 14 sampling zones around the country, including 10 counties in southeastern Wisconsin. It measured autism rates among eight-year-old children. The new statistics are from 2008; the comparative figures from the CDC's previous report were from 2006.
In the latest study, autism spectrum disorders were almost five times more common among boys than girls - one in 54 boys were identified with the disorder, compared to one in 252 girls. The largest increases occurred among Hispanic and black children.
The report also showed more children being diagnosed by age three, an uptick from 12 percent for children born in 1994 to 18 percent for children born in 2000.
While debate endures about the reason for the increased prevalence - and the new data is sure to stoke it - CDC director Thomas Frieden said one uncontestable fact emerged from the study.
"One thing the data tells us with certainty - there are more children and families that need help," Frieden said. "We must continue to track autism spectrum disorders because this is the information communities need to guide improvements in services to help children."
Why are rates increasing?
What's behind the upsurge?
Some say it can all be tracked back to increased awareness, better diagnosis and more liberal definitions of what autism really is; others insist the numerical escalation reflects actual increases in the incidence of the disorder. Announcing the new report, the Obama administration attempted to drive right down the middle of the road.
"Some of this increase is due to the way children are identified, diagnosed and served in their communities, although exactly how much is due to these factors is unknown," the CDC said in a statement.
After the report was released, the director of the National Institute of Mental Health, Thomas Insel, zigzagged back and forth.
"This takes us back to the central question: has the number of children with ASD [autism disorders] increased or not?" Insel asked on his blog. "Total population epidemiological studies suggest much or all of the increase is due to better and wider detection. Studies of administrative and services data suggest that better detection cannot fully explain the profound and continuing increase. Are we seeing more affected or more detected? The question is vitally important, but there is not one, simple answer just as autism is not a single, simple disorder."
If there is an increase in the number affected, Insel went on to say, then the causal factors needed to be discovered, and he pointed to analogous increases in food allergies, asthma, and Type 1 diabetes as sparking a search for environmental causes.
On the other hand, he wrote, if the number of children with ASD has not changed but is simply due to diagnosing and serving more of the population over the past two decades, then the focus needed to be on better diagnosis and treatments rather than looking for new environmental factors.
Insel pointed to true increases in other childhood maladies, to statistics from Korea showing a 2.6-percent prevalence rate there, and to a California study indicating a true increase in autism - all of which he said dictated caution.
"As diagnostic changes and ascertainment fail to explain the majority of the increase in autism prevalence, it seems prudent to assume that there are indeed more children affected and continue an aggressive search for causes while striving to improve detection, treatments, and services," he wrote. "Our working assumption is that there are both more children affected and more detected."
Other groups and individuals believe the federal government is not taking autism seriously. For instance, while Health and Human Services secretary Kathleen Sebelius talked last week about the "magnitude of the condition," federal officials have resisted calling autism an epidemic.
And that's odd, given the numbing statistics, some advocates say. Dan Olmsted, the editor of Age of Autism, observed that the American Academy of Pediatrics believes trampoline injuries are an epidemic, and the CDC believes obesity is an epidemic, but after spending $686 million in research and estimating one in 88 children to have autism, the CDC can't figure out whether autism is an epidemic.
The advocacy group SafeMinds has gone beyond Autism Awareness Month to declare Autism Crisis 2012, and said the growth trend in autism of about 12 percent a year was particularly disturbing. At that rate, the group stated, the number of children with autism would double every six years, and in just five years autism could affect one in 50 children and one in 31 boys, with at least one child with autism in every classroom in America.
The lack of concern by federal officials about those numbers has a direct funding impact, the group stated.
"The epidemic of individuals with autism is not being addressed by the federal government," the group stated. "When Congress extended the Combating Autism Act last September, the gridlock in Washington ensured that there was no additional money added despite the dramatic growth in the number of people with autism."
According to SafeMinds, the annual funding for all autism research and services is about $230 million - or about $315 per autistic child per year, given the CDC's past estimate of 730,000 people with autism. Indeed, the total 2011 National Institutes of Health budget was $30.5 billion. Of that, it directed only $169 million, or .6 percent, to autism research.
By contrast, the NIH spent $79 million on cystic fibrosis, $228 million on pediatric AIDS, and $170 million on pediatric cancer. All that reflects misguided priorities, SafeMinds said, when autism touches 45,454 babies every year, compared to 1,081 cases of cystic fibrosis, 13,333 instances of pediatric AIDS, and 800 cases of pediatric cancer.
"We have an epidemic on our hands," said Bob Wright, co-founder of another advocacy group, Autism Speaks. "The costs are staggering and will continue to rise as prevalence continues to increase. We know that early diagnosis and treatment are critical, so it is imperative that the U.S. government steps up its commitment to helping people living with autism today."
Autism Speaks recently produced research estimating U.S. autism costs soaring to $126 billion per year, more than triple the cost in 2006, and rising to $137 billion with the new prevalence numbers.
Richard Moore may be reached at firstname.lastname@example.org.