Age-Specific Time Trends in Incidence Rates of Autism Spectrum Disorder Following Adaptation of DSM-5 and Other ASD-Related Regulatory Changes in Israel.
Autism diagnoses in Israel keep climbing fastest in toddlers, and policy changes make no dent.
01Research in Context
What this study did
Davidovitch et al. (2020) counted every new autism diagnosis in Israel from 2007 to 2018.
They used the national registry. Kids were tracked from birth to age 18.
The team looked for any dip or jump after DSM-5 came out in 2013 and after local policy changes.
What they found
Autism rates more than doubled. The climb was fastest in toddlers and preschoolers.
DSM-5 and new rules did not slow or speed the rise. Growth stayed steady.
How this fits with other research
Raz et al. (2015) saw a 10-fold surge from 1992-2004, then a flat line 2005-2009. Michael’s data pick up where Raanan left off and show the climb restarted.
Pinborough-Zimmerman et al. (2012) found the same doubling in Utah school and health records 2002-2008. Two countries, same curve.
Saloner et al. (2019) showed Kansas insurance mandates doubled therapy use. Michael found no change in new cases after policy tweaks. Together they hint: policy can open doors, but it does not create more autism.
Why it matters
Expect your caseload to keep growing, especially with 2- and 3-year-olds. Policies and new manuals will not stop the wave. Line up early-intervention slots, train more RBTs, and warn funders that numbers are still rising.
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02At a glance
03Original abstract
We analyzed data on 879,029 children born in 1999-2017 from a large Israeli health fund to evaluate time-trends in incidence of autism spectrum disorder (ASD). This included examining possible effects associated with the adaptation of the DSM-5 criteria for ASD, and the implementation of regulatory changes affecting eligibility for ASD-related stipends and services. ASD cases were ascertained based on electronic medical records review, with complete verification of ASD case status. Results indicated a substantial increase in ASD incidence rate (IR) over time that was overall not appreciably affected by the above changes. Cumulative incidence through age 8 rose from 0.46% (boys: 0.73; girls: 0.18) in 2007 to 1.30% (boys: 2.12; girls: 0.45) in 2018. Age-specific analyzes indicated that the largest increase in IR occurred in toddlers and preschool children, with a more modest increase at older age groups. Results suggest that the rise in early diagnosed ASD does not stem from a downward shift in the distribution of ages at first diagnosis, but rather from early detection of cases not previously diagnosed. Findings highlight the need to expand research aimed at identifying exogenous factors that may underlie the rise in incidence, and to evaluate factors that may contribute to late diagnosis of some cases. Autism Res 2020, 13: 1893-1901. © 2020 International Society for Autism Research and Wiley Periodicals LLC LAY SUMMARY: In an analysis of nearly 900,000 Israeli children born in 1999-2017, we found that the incidence of autism spectrum disorder (ASD) increased significantly over time, especially among toddlers and preschool children but also at older age groups. We additionally observed that changes affecting diagnostic criteria for ASD and eligibility for ASD-related services did not appreciably affect these trends. Results highlight the need to continue research aimed at identifying factors causing this increase and reasons contributing to late diagnosis of some cases.
Autism research : official journal of the International Society for Autism Research, 2020 · doi:10.1002/aur.2420