Autism cases continue to rise in the U.S., where 1 in 88 children has been diagnosed with the disorder by age 8, according to figures released Thursday. The rate was determined with 2008 data from 14 communities including St. Louis and updates the previous estimate that 1 in 110 children has autism.
The rate is even higher in Missouri, where an estimated 1 in 72 children has autism. Figures for Illinois were not included in the study from the U.S. Centers for Disease Control and Prevention.
Researchers, including a team from Washington University, found autism spectrum disorders are nearly five times more common in boys than girls, with 1 in 54 boys affected, according to the report.
Autism rates varied widely by geography, from 1 in 47 children in Utah to 1 in 210 children in Alabama.
The researchers studied the medical and school records of more than 337,000 children nationwide and found specific descriptions of autism behaviors and diagnoses in 3,820 cases. In Missouri, 357 children out of 25,668 studied were identified as having an autism spectrum disorder. The Washington University researchers were only granted access to medical records because of the state's interpretation of educational privacy laws.
"Ideally we'd be able to screen every child in our community and determine whether they have an autism spectrum disorder, but resources just don't allow us to do so," said Robert Fitzgerald, a staff scientist in psychiatry at Washington University. "There is a possibility that we are missing kids."
At nearly every site, including Missouri, there were higher rates of autism among white children compared with other races.
The racial discrepancies in autism rates could be a factor of access to medical care in minority communities, although the gap appears to be closing over time, Fitzgerald said.
The largest increases in autism cases since the last report were seen in Hispanic and black children, the researchers found.
"The community is doing a better job at identifying and making the diagnosis in these children," Fitzgerald said.
Between 2002 and 2008, there was a 78 percent overall increase in children identified with autism.
Experts can't pinpoint whether there are truly more children with autism now than ever, because it is possible that the increase is caused entirely by an expansion of the definition of autism, improved detection by doctors and a greater awareness of the disorder, said Thomas Frieden, director of the CDC, in a conference call with reporters.
"What we do know for certain is autism is common and needs to be effectively served," he said.
Not enough is known about the genetic and environmental causes of the developmental disorder, said Coleen Boyle, director of the National Center on Birth Defects and Developmental Disabilities, during the call.
"We know people want answers to what's causing this increase, and so do we," Boyle said. "To understand more, we need to keep accelerating our research into risk factors and causes."
Boyle said potential risk factors for autism may be culled from the study and other data, which so far has linked advanced parental age and premature birth with higher rates of autism.
Although most children with autism are diagnosed after age 4, more children are now getting earlier diagnoses when interventions are most effective, according to the study. The median age at diagnosis dropped from 4.5 years old in 2006 to 4 years old in 2008, researchers said.
The American Academy of Pediatrics recommends that children be screened for autism starting at 18 months old.
"It's important for parents who have concerns to bring them up and be persistent," said Dr. Susan Hyman of the academy.
Early interventions with behavior and language therapy is believed to give children with autism a better prognosis and improves their chances of being in mainstream classrooms.
"You'd rather err on the side of overdiagnosing," Ron Ekstrand, said CEO of TouchPoint Autism Services. "The treatment isn't surgery, the treatment is behavior therapy, and most children would benefit by having behavioral intervention."
The country needs to train more therapists and teachers to address the increasing needs of children and adults with autism, said Mark Roithmayr, president of Autism Speaks advocacy group, in the call.
"This is a national emergency in need of a national plan," Roithmayr said.
Even with the increase in cases, Missouri in the last five years has reduced the waiting period for an appointment after a child is referred for an autism assessment from 18 months to one month, according to Dr. Rolanda Maxim, director of the Knights of Columbus Developmental Center at Cardinal Glennon Children's Medical Center.
"We have increased the number of professionals screening, training and collaborating," Maxim said. "I think we're really in good shape."
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