Barbara L. Trommer MD Pediatric Neurology . Associate Director, Maimonides Developmental Center . Medical School: Columbia University . Fellowship: Children's Memorial Hospital Northwestern University Medical School Pediatric Neurology
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Is there any increase in prevalence? I am going to evade answering that question directly but I am going to give you some fact that addresses that question. One is, we have greater awareness, parents have greater awareness. We have better ascertainment because doctors are better at making this diagnosis than we were 10 or 15 years ago. Criteria have changed. The DSM III introduce the term Autistic disorder in 1980, that immediately had the effect of increasing the prevalence, just by how we counted it. In 1987, the DSM-III-R introduced PDD, Not Otherwise Specified. That embraced a much larger population of patients who are now qualified for this diagnosis. Then in 1994 with the DSM-IV although there was an effort to make the diagnostic criteria for Autistic disorder more precise and which you would think would have the effect of decreasing the prevalence, Asperger syndrome was introduced as a diagnosis. So again, there was a actually a broadening of the number of patients who would be included in this diagnosis. And then in 1990, two other things happened IDEA, the Individuals with Disability Education Act was introduced and we saw a lot of diagnostic substitution so that students who previously in order to qualify for services had to have diagnosis of mental retardation or speech impairment or learning disabilities, could now qualify for services under the diagnosis of Artistic disorder and therefore many were reclassified, again increasing the prevalence. And then the Americans with Disabilities Act also in 1990 made it possible for previously institutionalize children to live at home and to attend community schools and thus be counted in the educational prevalence data. So you get my sense that although we speak a lot about epidemic, in fact much perhaps the majority of big increase that we are seeing can be attributed to changing diagnostic criteria and reclassification.

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