I'm Dr. John Iskander and welcome
to CDC's Beyond the Data.
I'm here today with Jon Baio from CDC's National Center
on Birth Defects and Developmental Disabilities.
Jon was one of our featured speakers
for this month's Grand Round session
on Autism Spectrum Disorder.
Jon, what can you tell us about the new definitions
and criteria for Autism?
Well, this is a topic that's been
of great concern to a lot of people.
In 2013 the American Psychiatric Association published the
diagnostic and statistical manual version 5
which updated the definition
of what was previously pervasive developmental disorders
and created a new definition for Autism Spectrum disorder.
Now the criteria for diagnosis have changed
and there's a concern that some children
who previously met the diagnostic criteria
in the previous version will no longer meet it moving forward.
Now because of the way that we collect data and because
of the methods that I've described
in this month's Public Health Grand Rounds we will be able
to concurrently apply a case definition based on the DSM4
and one based on the DSM5 and it will enable us to compare
and contrast those two definitions and understand
which children will no longer meet the criteria
under the new definition.
So we now speak of Autism Spectrum Disorder rather
than the previous more varied terminology.
So as one of CDC's leading experts on Autism surveillance,
take us behind the numbers a little bit.
What are the findings from the newest surveillance data
and what have we learned?
Well we've been doing this for almost 15 years and over
that time we've seen over a doubling
of the prevalence estimates from our earliest reports.
Now there are certainly many reasons why that might be so.
But some of the most important differences
that we've seen is really a changing of the landscape
of the children who are classified
with autism in these communities.
And so we see a lot more children now
who are functioning normally in classrooms, have average
to above average intelligence,
and have a great capacity to learn.
However their autism is interfering with their ability
to learn in these environments and we are seeing more and more
of these children who are being served in a variety
of settings in the community.
So we know that that has something to do with the numbers
that we've seen over the years.
But, we still don't know very much about the causes of autism
and we don't know much about the services and the programs
in these communities that are expanding to meet the demand
of services for these individuals.
Okay, so we certainly have the numbers showing an increase
in estimated prevalence
but as you said it may be a more complex reality behind that.
Tell us some of what we learned in recent years
about the causes of autism.
Well, there're certainly new findings from a variety
of research and epidemiologic studies.
Most of them do however point to better recognition
and improved access to services and diagnostic,
diagnostic services for these individuals.
We do find a great number
of socio economic disparities in the data.
We find very low prevalence among lower socio economic
groups and much higher prevalence among higher socio
economic groups.
And to us that really speaks to better ascertainment
and better access to programs among children with resources
who are able to access those programs.
And so we know that that some of it,
some of the other research that's come out points to things
like advance parental age, certainly a risk factor
for a number of birth defects
and developmental disabilities including autism,
prematurity, low birth weight.
Those are all factors that play into the risk
of a child having autism.
However those things haven't changed very much
over the time period that we're talking
about so there's obviously something else going
on behind the scenes.
So, again, a lot of, a lot
of evidence suggesting a complex web,
web of causes underlying some of the numbers we're seeing.
So you talked about the need for communities
to ensure access to services.
What can you tell us about early screening and diagnosis,
what should our goals be there?
Well we know that the earlier a child gets recognized
as having a delay and linked to services the greater potential
for the long term impact of those services.
And we have a lot of efforts underway across the country
to improve early identification and screening for autism
and we're working closely with a lot of partners
to help implement those recommendations
in public health settings.
Now, in our data, we really see not much change in the age
when children are initially diagnosed
and referred for services.
We see a much larger number of children than ever before
who are diagnosed but the age and the central tendency
of that has really remained about the same at about,
about four and a half years.
And that's really too late for, to get the maximum benefit
of the early treatment services that are available.
We would like to see that, that age of diagnosis move closer
to age two or three when it is really possible
to diagnose a child with autism.
So this is a complex topic but what can you tell us
about the current state of the art of treatment
for children with autism?
Well, most of the treatments
that are commonly prescribed now are behavioral based treatments
that are meant to improve children's socialization
and their reaction to sensory stimuli.
And these can be affective at any age obviously
but we would really like to see children begin those treatments
as soon as possible so that they can receive the long term
benefits of them.
Thank you very much.
Please join us next month for CDC's Beyond the Data.